Flexible endoscopic stitching devices

ABSTRACT

An endoscopic stitching device including a tool assembly having a pair of juxtaposed jaws; a rotatably supported camming hub defining a groove formed in an inner surface of a central lumen thereof; and a center rod slidably and rotatably disposed within the lumen of the camming hub. The center rod is operatively engaged with the groove formed in the camming hub and engaged with the pair of jaws. The inner groove of the camming hub is configured such that, in at least one position, axial translation of the center rod relative to the camming hub results in rotation of the camming hub and at least one of opening and closing of the pair of jaws. The inner groove of the camming hub is configured such that, in at least one other position, rotation of the canter rod results in rotation of the tool assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a National Stage Application of PCT/US2007/021495filed Oct. 5, 2007 under 35 USC §371 (a), which claims benefit of andpriority to U.S. Provisional Patent Application Ser. No. 60/849,561filed Oct. 5, 2006; U.S. Provisional Patent Application Ser. No.60/849,562 filed Oct. 5, 2006; U.S. Provisional Patent Application Ser.No. 60/849,508 filed Oct. 5, 2006; U.S. Provisional Patent ApplicationSer. No. 60/923,804 filed Apr. 16, 2007; U.S. Provisional PatentApplication Ser. No. 60/923,980 filed Apr. 17, 2007 and U.S. ProvisionalPatent Application Ser. No. 60/958,474 filed Jul. 6, 2007 thedisclosures of each of the above-identified applications are herebyincorporated by reference in their entirety.

BACKGROUND

1. Technical Field

The present disclosure relates to devices, systems and methods forendoscopic suturing or stitching and, more particularly, to endeffectors, systems and methods for endoscopic suturing and/or stitchingthrough an access tube or the like.

2. Background

As medical and hospital costs continue to increase, surgeons areconstantly striving to develop advanced surgical techniques. Advances inthe surgical field are often related to the development of operativetechniques which involve less invasive surgical procedures and reduceoverall patient trauma. In this manner, the length of hospital stays canbe significantly reduced, and, therefore, the hospital and medical costscan be reduced as well.

One of the truly great advances in recent years to reduce theinvasiveness of surgical procedures is endoscopic surgery. Generally,endoscopic surgery involves incising through body walls for example,viewing and/or operating on the ovaries, uterus, gall bladder, bowels,kidneys, appendix, etc. There are many common endoscopic surgicalprocedures, including arthroscopy, laparoscopy (pelviscopy),gastroentroscopy and laryngobronchoscopy, just to name a few. Typically,trocars are utilized for creating the incisions through which theendoscopic surgery is performed. Trocar tubes or cannula devices areextended into and left in place in the abdominal wall to provide accessfor endoscopic surgical tools. A camera or endoscope is inserted througha relatively large diameter trocar tube which is generally located atthe naval incision, and permits the visual inspection and magnificationof the body cavity. The surgeon can then perform diagnostic andtherapeutic procedures at the surgical site with the aid of specializedinstrumentation, such as, forceps, cutters, applicators, and the likewhich are designed to fit through additional cannulas. Thus, instead ofa large incision (typically 12 inches or larger) that cuts through majormuscles, patients undergoing endoscopic surgery receive morecosmetically appealing incisions, between 5 and 10 millimeters in size.Recovery is, therefore, much quicker and patients require lessanesthesia than traditional surgery. In addition, because the surgicalfield is greatly magnified, surgeons are better able to dissect bloodvessels and control blood loss. Heat and water loss are greatly reducedas a result of the smaller incisions.

In many surgical procedures, including those involved in endoscopicsurgery, it is often necessary to suture bodily organs or tissue. Thelatter is especially challenging during endoscopic surgery because ofthe small openings through which the suturing of bodily organs ortissues must be accomplished.

In the past, suturing of bodily organs or tissue through endoscopicsurgery was achieved through the use of a sharp metal suture needlewhich had attached at one of its ends a length of suture material. Thesurgeon would cause the suture needle to penetrate and pass throughbodily tissue, pulling the suture material through the bodily tissue.Once the suture material was pulled through the bodily tissue, thesurgeon proceeded to tie a knot in the suture material. The knotting ofthe suture material allowed the surgeon to adjust the tension on thesuture material to accommodate the particular tissue being sutured andcontrol approximation, occlusion, attachment or other conditions of thetissue. The ability to control tension is extremely important to thesurgeon regardless of the type of surgical procedure being performed.

However, during endoscopic surgery, knotting of the suture material istime consuming and burdensome due to the difficult maneuvers andmanipulation which are required through the small endoscopic openings.

Many attempts have been made to provide devices to overcome thedisadvantages of conventional suturing. Such prior art devices haveessentially been staples, clips, clamps or other fasteners. However,none of these above listed devices overcome the disadvantages associatedwith suturing bodily tissue during endoscopic surgery.

Accordingly, there is a need for improvements in suturing devices whichovercome the shortcomings and drawbacks of prior art apparatus.

SUMMARY

The present disclosure relates to end effectors, systems and methods forendoscopic suturing and/or stitching through an access tube or the like.

According to an aspect of the present disclosure, an endoscopicstitching device is provided, including an articulatable neck assemblyconfigured and adapted for articulation in at least one directiontransverse to a longitudinal axis thereof; a tool assembly operativelysupported on a distal end of the neck assembly; and a suture needleoperatively associated with the tool assembly. The tool assemblyincludes a pair of juxtaposed jaws pivotally associated with oneanother. Each jaw defines a needle receiving recess formed in a tissuecontacting surface thereof.

The tool assembly of the endoscopic stitching device may further includean axially translatable needle engaging blade slidably supported in eachjaw. Each blade includes an advanced position wherein a distal end ofthe blade engages the suture needle when the suture needle is in therespective jaw to thereby secure the suture needle therewith. Each bladeincludes a retracted position wherein a distal end of the blade is outof engagement with the suture needle. The pair of blades may beoperatively joined to one another so as to translate in oppositedirections relative to one another.

The endoscopic stitching device includes an actuation cable translatablyextending through the neck assembly and operatively connected to thepair of jaws. The actuation cable includes a first position wherein thejaws are spaced apart from one another and a second position wherein thepair of jaws are in close spaced relation to one another. The actuationcable may be disposed along a central axis of the neck assembly.

The endoscopic stitching device may further include at least onearticulation cable slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly. Thearticulation cable may be disposed along an axis spaced a distance fromthe central axis of the neck assembly. The endoscopic stitching devicemay include a pair of articulation cables slidably extending through theneck assembly along opposed sides of the actuation cable.

The endoscopic stitching device further includes a camming hub keyed toa distal end of the actuation cable so as to enable axial movement ofthe actuation cable relative to the camming hub. The camming hub rotatesupon a rotation of the actuation cable. The camming hub is operativelyconnected to a proximal end of each blade in such a manner that rotationof the camming hub results in axial translation of each of the pair ofblades.

The suture needle may include a length of barbed suture extendingtherefrom.

According to another aspect of the present disclosure, an endoscopicstitching device is provided including an end effector configured andadapted to perform at least a pair of functions; and a single actuationcable operatively connected to the end effector. The actuation cable iscapable of effecting operation of at least the pair of functions. Theactuation cable is capable of effecting a first operation of the pair offunctions upon an axial translation thereof; and a second operation ofthe pair of functions upon a rotation thereof.

The end effector may include a tool assembly operatively supported on adistal end of an articulatable neck assembly. The neck assembly may beconfigured and adapted for articulation in at least one directiontransverse to a longitudinal axis thereof.

The endoscopic stitching device may further include a suture needleoperatively associated with the tool assembly. The tool assembly mayinclude a pair of juxtaposed jaws pivotally associated with one another.Each jaw may define a needle receiving recess formed in a tissuecontacting surface thereof.

The endoscopic stitching device may further include an axiallytranslatable needle engaging blade slidably supported in each jaw. Eachblade may include an advanced position wherein a distal end of the bladeengages the suture needle when the suture needle is in the respectivejaw to thereby secure the suture needle therewith, and wherein eachblade may include a retracted position wherein a distal end of the bladeis out of engagement with the suture needle. The pair of blades may beoperatively joined to one another so as to translate in oppositedirections relative to one another upon a rotation of the actuationcable. In use, axial, reciprocal translation of the actuation cable mayresult in opening and closing of the pair of jaws.

The actuation cable may translatably extend through the neck assembly.The actuation cable may include a first position wherein the jaws arespaced apart from one another and a second position wherein the pair ofjaws are in close spaced relation to one another.

The endoscopic stitching device may further include at least onearticulation cable slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly. Thearticulation cable may be disposed along an axis spaced a distance froma central axis of the neck assembly.

The endoscopic stitching device may further include a camming hub keyedto the actuation cable so as to enable an axial translation of theactuation cable relative to the camming hub. In use, the camming hub mayrotate upon a rotation of the actuation cable. The camming hub may beoperatively connected to a proximal end of each blade in such a mannerthat rotation of the camming hub results in axial translation of each ofthe pair of blades.

The suture needle may include a length of barbed suture extendingtherefrom.

According to a further aspect of the present disclosure, an endoscopicstitching device is provided which includes an articulatable neckassembly configured and adapted for articulation in at least onedirection transverse to a longitudinal axis thereof; and a tool assemblyoperatively supported on a distal end of the neck assembly. The toolassembly also includes a pair of juxtaposed jaws pivotally associatedwith one another, each jaw defining a needle receiving recess formed ina tissue contacting surface thereof; a rotatably supported camming hub,the camming hub defining a central lumen therethrough and a helicalgroove formed in an outer surface thereof; a pair of axiallytranslatable needle engaging blades slidably supported, one each, in arespective jaw, each blade having an advanced position wherein a distalend of the blade engages a suture needle when the suture needle is inthe respective jaw to thereby secure the suture needle to the jaw, and aretracted position wherein the distal end of the blade is out ofengagement with the suture needle to thereby permit the suture needle tobe removed from the jaw, wherein a proximal end of each blade isconfigured for slidable engagement in the helical groove of the camminghub. The endoscopic stitching device further includes a suture needleoperatively associated with the tool assembly.

In use, rotation of the camming hub may result in reciprocal axialtranslation of the pair of blades in opposite directions to one another.

The camming hub may define a first clutch formed in a proximal surfacethereof. The endoscopic stitching device may further include a secondclutch selectively engageable with the first clutch of the camming hub.In use, rotation of the second clutch, when engaged with the firstclutch, may result in rotation of the camming hub.

The second clutch may be axially translatable relative to the camminghub between an engaged position and a disengaged position. In use, it iscontemplated that rotation of the second clutch when in the disengagedposition will impart no rotation to the camming hub. The second clutchmay be rotatably supported on a distal end of shaft. The shaftsupporting the second clutch may be hollow.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the hollow shaft. A distalend of the actuation cable may be operatively connected to the pair ofjaws. The actuation cable may include a first position wherein the jawsare spaced apart from one another and a second position wherein the pairof jaws are in close spaced relation to one another.

The endoscopic stitching device may further include a pair ofarticulation cables slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly.

The suture needle may include a barbed suture.

The endoscopic stitching device may further include a jaw support memberdefining a lumen therethrough and a clevis at a distal end thereof. Thepair of jaws may be pivotably supported in the clevis and the camminghub may be rotatably supported in the lumen of the jaw support member.The jaw support member may define a pair of opposed axially extendinggrooves formed in a surface thereof, wherein the grooves may beconfigured to slidably receive a respective blade therein.

According to yet another aspect of the present disclosure, an endoscopicstitching device is provided and includes a tool assembly having a pairof juxtaposed jaws pivotally associated with one another, each jawdefining a needle receiving recess formed in a tissue contacting surfacethereof; a selectively rotatably camming hub defining a central lumentherethrough and a helical groove formed in an outer surface thereof; apair of axially translatable needle engaging blades slidably supported,one each, in a respective jaw, each blade having an advanced positionwherein a distal end of the blade engages a suture needle when thesuture needle is in the respective jaw to thereby secure the sutureneedle to the jaw, and a retracted position wherein the distal end ofthe blade is out of engagement with the suture needle to thereby permitthe suture needle to be removed from the jaw, wherein a proximal end ofeach blade is configured for slidable engagement in the helical grooveof the camming hub; and a suture needle operatively associated with thetool assembly.

The endoscopic stitching device may further include a neck assemblyconfigured to support the tool assembly on a distal end thereof. Theneck assembly may be articulatable in at least one direction transverseto a longitudinal axis thereof.

The camming hub may define a first clutch formed in a proximal surfacethereof. The endoscopic stitching device may further include a secondclutch selectively engageable with the first clutch of the camming hub,wherein rotation of the second clutch, when engaged with the firstclutch, results in rotation of the camming hub. In use, rotation of thecamming hub may result in reciprocal axial translation of the pair ofblades in opposite directions to one another.

The second clutch may be axially translatable relative to the camminghub between an engaged position and a disengaged position. In use,rotation of the second clutch when in the disengaged position willimpart no rotation to the camming hub. The second clutch may berotatably supported on a distal end of shaft. The shaft supporting thesecond clutch may be hollow.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the hollow shaft, wherein adistal end of the actuation cable is operatively connected to the pairof jaws. The actuation cable may include a first position wherein thejaws are spaced apart from one another and a second position wherein thepair of jaws are in close spaced relation to one another.

The endoscopic stitching device may further include a pair ofarticulation cables fixedly connected to the tool assembly, whereinretraction of one of the pair of articulation cables may result inarticulation of the tool assembly in a first direction, and retractionof the other of the pair of articulation cables may result inarticulation of the tool assembly in a second direction.

The suture needle may include a barbed suture.

The endoscopic stitching device may further include a jaw support memberdefining a lumen therethrough and a clevis at a distal end thereof,wherein the pair of jaws are pivotably supported in the clevis and thecamming hub is rotatable supported in the lumen of the jaw supportmember. The jaw support member may define a pair of opposed axiallyextending grooves formed in a surface thereof, wherein the grooves areconfigured to slidably receive a respective blade therein.

According to yet another embodiment of the present disclosure, anendoscopic stitching device is provided which includes an articulatableneck assembly configured and adapted for articulation in at least onedirection transverse to a longitudinal axis thereof; and a tool assemblyoperatively supported on a distal end of the neck assembly. The toolassembly includes a pair of juxtaposed jaws pivotally associated withone another, each jaw defining a needle receiving recess formed in atissue contacting surface thereof; a rotatably supported camming hub,the camming hub defining a central lumen therethrough and a grooveformed in an inner surface thereof; and a center rod slidably androtatably disposed within the lumen of the camming hub. The center rodis operatively engaged with the groove formed in the inner surface ofthe camming hub and being operatively engaged with the pair of jaws. Theendoscopic stitching device further includes a suture needle operativelyassociated with the tool assembly. The inner groove of the camming hubis configured such that, in at least one position, axial translation ofthe center rod relative to the camming hub results in rotation of thecamming hub and at least one of opening and closing of the pair of jaws;and the inner groove of the camming hub is configured such that, in atleast one other position, rotation of the canter rod results in rotationof the tool assembly.

The groove formed in the inner surface of the camming hub may include apair of diametrically opposed axially oriented grooves, and a pair ofhelical grooves interconnecting the axially oriented grooves.

The tool assembly may further include a pair of axially translatableneedle engaging blades slidably supported, one each, in a respectivejaw. Each blade may have an advanced position wherein a distal end ofthe blade engages a suture needle when the suture needle is in therespective jaw to thereby secure the suture needle to the jaw, and aretracted position wherein the distal end of the blade is out ofengagement with the suture needle to thereby permit the suture needle tobe removed from the jaw.

The camming hub may define a helical groove formed in an outer surfacethereof, and a proximal end of each blade may be configured for slidableengagement in the helical groove of the camming hub. In use, rotation ofthe camming hub may result in reciprocal axial translation of the pairof blades in opposite directions to one another.

The tool assembly may include a support member defining a lumen therein.The camming hub may be rotatably supported in the lumen of the supportmember, and the camming hub may be fixed against movement within thelumen of the support member. The camming hub may define an annulargroove formed in the outer surface thereof, wherein the outer annulargroove of the camming hub may slidably receive a projection of thesupport member therein.

The endoscopic stitching device further includes an actuation cabletranslatably and rotatably extending through the neck assembly, whereina distal end of the actuation cable is operatively connected to thecenter rod. The actuation cable may be translatable to axially translatethe center rod between a first position wherein the jaws are spacedapart from one another and a second position wherein the pair of jawsare in a close spaced relation to one another.

The endoscopic stitching device may further include a pair ofarticulation cables slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly.

The suture needle may include a barbed suture.

The tool assembly may further include a keyed block disposed distally ofthe camming hub. The keyed block may define a lumen therethrough and apair of diametrically opposed, axially extending grooved formed in aninner surface of the lumen. The axial grooves may be configured toslidably receive a respective blade therein.

According to still another aspect of the present disclosure, anendoscopic stitching device is provided and includes a tool assembly.The tool assembly includes a pair of juxtaposed jaws pivotallyassociated with one another; a rotatably supported camming hub, thecamming hub defining a central lumen therethrough and a groove formed inan inner surface thereof; and a center rod slidably and rotatablydisposed within the lumen of the camming hub, the center rod beingoperatively engaged with the groove formed in the inner surface of thecamming hub and being operatively engaged with the pair of jaws. Theinner groove of the camming hub is configured such that, in at least oneposition, axial translation of the center rod relative to the camminghub results in rotation of the camming hub and at least one of openingand closing of the pair of jaws. The inner groove of the camming hub isconfigured such that, in at least one other position, rotation of thecanter rod results in rotation of the tool assembly.

The endoscopic stitching device may further include an articulatableneck assembly configured and adapted for articulation in at least onedirection transverse to a longitudinal axis thereof. The tool assemblymay be supported on a distal end of the neck assembly.

Each jaw may define a needle receiving recess formed in a tissuecontacting surface thereof.

The groove formed in the inner surface of the camming hub may include apair of diametrically opposed axially oriented grooves, and a pair ofhelical grooves interconnecting the axially oriented grooves.

The tool assembly may further include a pair of axially translatableneedle engaging blades slidably supported, one each, in a respectivejaw. Each blade may have an advanced position wherein a distal end ofthe blade engages a suture needle when the suture needle is in therespective jaw to thereby secure the suture needle to the jaw, and aretracted position wherein the distal end of the blade is out ofengagement with the suture needle to thereby permit the suture needle tobe removed from the jaw.

The camming hub may define a helical groove formed in an outer surfacethereof, and wherein a proximal end of each blade may be configured forslidable engagement in the helical groove of the camming hub. In use,rotation of the camming hub may result in reciprocal axial translationof the pair of blades in opposite directions to one another.

The tool assembly may include a support member defining a lumen therein,wherein the camming hub is rotatably supported in the lumen of thesupport member, and wherein the camming hub is fixed against movementwithin the lumen of the support member. The camming hub may define anannular groove formed in the outer surface thereof. The outer annulargroove of the camming hub may slidably receive a projection of thesupport member therein.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the neck assembly, whereina distal end of the actuation cable may be operatively connected to thecenter rod. The actuation cable may be translatable to axially translatethe center rod between a first position wherein the jaws are spacedapart from one another and a second position wherein the pair of jawsare in a close spaced relation to one another.

The endoscopic stitching device may further include a pair ofarticulation cables slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly.

The tool assembly may further include a keyed block disposed distally ofthe camming hub. The keyed block defines a lumen therethrough and a pairof diametrically opposed, axially extending grooves formed in an innersurface of the lumen. The axial grooves may be configured to slidablyreceive a respective blade therein.

The endoscopic stitching device may further include a suture needleoperatively associated with the tool assembly. The suture needle mayinclude a barbed suture.

According to still another aspect of the present disclosure anendoscopic stitching device is provided including an articulatable neckassembly configured and adapted for articulation in at least onedirection transverse to a longitudinal axis thereof; and a tool assemblyoperatively supported on a distal end of the neck assembly. The toolassembly includes a pair of juxtaposed jaws pivotally associated withone another, each jaw defining a needle receiving recess formed in atissue contacting surface thereof; a drive assembly including a pair ofconcentric, individually rotatably and translatably supported barrels,each barrel defining a central lumen therethrough; and a pair of axiallytranslatable needle engaging blades slidably supported, one each, in arespective jaw, each blade having an advanced position wherein a distalend of the blade engages a suture needle when the suture needle is inthe respective jaw to thereby secure the suture needle to the jaw, and aretracted position wherein the distal end of the blade is out ofengagement with the suture needle to thereby permit the suture needle tobe removed from the jaw, wherein a proximal end of each blade isrotatably connected to a respective barrel. The endoscopic stitchingdevice further includes a center rod slidably and rotatably disposedthrough the lumen of the barrels, a distal end of the center rod beingoperatively engaged with the pair of jaws; and a suture needleoperatively associated with the tool assembly.

An outer barrel of the pair of concentric barrels may define an annulargroove formed in a surface of the lumen thereof, and an inner barrel ofthe pair of concentric barrels may define an annular groove formed in anouter surface thereof. Each blade may include a ring supported at aproximal end thereof, wherein the ring of each blade is rotatablydisposed in a respective one of the grooves formed in the outer andinner barrels.

The endoscopic stitching device may further include a pair of pusherrods operatively connected, one each, to a respective inner and outerbarrel, wherein axial translation of the pusher rods results incorresponding axial translation of a respective inner and outer barreland a respective one of the pair of blades. The pusher rods may beflexible.

The tool assembly may include a support member defining a lumen therein.The barrels of the drive assembly may be supported in the lumen of thesupport member in such a manner so as to permit rotation and axialtranslation thereof. The endoscopic stitching device may further includean actuation cable translatably and rotatably extending through thelumen defined by the barrels of the drive assembly, wherein a distal endof the actuation cable is operatively connected to the center rod suchthat rotation of the actuation cable results in rotation of the pair ofjaws. The actuation cable may be translatable to axially translate thecenter rod between a first position wherein the jaws are spaced apartfrom one another and a second position wherein the pair of jaws are in aclose spaced relation to one another.

The endoscopic stitching device may further include a camming hubrotatably supported proximally of the pair of barrels. The camming hubmay define a central lumen through which the center rod passes and ahelical groove formed in an outer surface thereof.

Each of the pair of barrels may include an arm extending proximallytherefrom. Each arm may be operatively engaged in the helical groove ofthe camming hub. The arms extending from the pair of barrels arediametrically opposed to one another, wherein rotation of the camminghub results in reciprocal axial translation of the pair of barrelsrelative to one another.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the lumen defined by thebarrels of the drive assembly. A distal end of the actuation cable maybe operatively connected to the center rod such that rotation of theactuation cable results in rotation of the pair of jaws. The actuationcable may be translatable to axially translate the center rod between afirst position wherein the jaws are spaced apart from one another and asecond position wherein the pair of jaws are in a close spaced relationto one another.

The endoscopic stitching device may further include a hollow shaftextending proximally from the camming hub. The actuation cable mayextend through a lumen of the hollow shaft.

The drive assembly may include a pair of axially spaced apart barrels.Each barrel may be axially translatable. A distal barrel of the pair ofbarrels may define an annular groove formed in an outer surface thereof,and a proximal barrel of the pair of barrels may define an annulargroove formed in an outer surface thereof. Each blade may include a ringsupported at a proximal end thereof. The ring of each blade may berotatably disposed in a respective one of the grooves formed in thedistal and proximal barrels.

The endoscopic stitching device may further include a pair of pusherrods operatively connected, one each, to a respective distal andproximal barrel. In use, axial translation of the pusher rods may resultin corresponding axial translation of a respective distal and proximalbarrel and a respective one of the pair of blades.

According to another aspect of the present disclosure, an endoscopicstitching device is provided which includes a tool assembly. The toolassembly includes a pair of juxtaposed jaws pivotally associated withone another, each jaw defining a needle receiving recess formed in atissue contacting surface thereof; a drive assembly including a pair ofconcentric, individually rotatably and translatably supported barrels,each barrel defining a central lumen therethrough; and a pair of axiallytranslatable needle engaging blades slidably supported, one each, in arespective jaw. Each blade has an advanced position wherein a distal endof the blade engages a suture needle when the suture needle is in therespective jaw to thereby secure the suture needle to the jaw, and aretracted position wherein the distal end of the blade is out ofengagement with the suture needle to thereby permit the suture needle tobe removed from the jaw, wherein a proximal end of each blade isrotatably connected to a respective barrel. The tool assembly furtherincludes a center rod slidably and rotatably disposed through the lumenof the barrels, wherein a distal end of the center rod is operativelyengaged with the pair of jaws.

The endoscopic stitching device may further include an articulatableneck assembly to operatively support the tool assembly at a distal endthereof. The neck assembly may be configured and adapted forarticulation in at least one direction transverse to a longitudinal axisthereof.

An outer barrel of the pair of concentric barrels may define an annulargroove formed in a surface of the lumen thereof, and an inner barrel ofthe pair of concentric barrels may define an annular groove formed in anouter surface thereof. Each blade may include a ring supported at aproximal end thereof. The ring of each blade may be rotatably disposedin a respective one of the grooves formed in the outer and innerbarrels.

The endoscopic stitching device may further include a pair of pusherrods operatively connected, one each, to a respective inner and outerbarrel. In use, axial translation of the pusher rods may result incorresponding axial translation of a respective inner and outer barreland a respective one of the pair of blades. The pusher rods may beflexible.

The tool assembly may include a support member defining a lumen therein,wherein the barrels of the drive assembly are supported in the lumen ofthe support member in such a manner so as to permit rotation and axialtranslation thereof.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the lumen defined by thebarrels of the drive assembly. A distal end of the actuation cable maybe operatively connected to the center rod such that rotation of theactuation cable may result in rotation of the pair of jaws. Theactuation cable may be translatable to axially translate the center rodbetween a first position wherein the jaws are spaced apart from oneanother and a second position wherein the pair of jaws are in a closespaced relation to one another.

The endoscopic stitching device may further include a camming hubrotatably supported proximally of the pair of barrels. The camming hubmay define a central lumen through which the center rod passes and ahelical groove formed in an outer surface thereof.

Each of the pair of barrels may include an arm extending proximallytherefrom. Each arm may be operatively engaged in the helical groove ofthe camming hub. The arms extending from the pair of barrels may bediametrically opposed to one another. In use, rotation of the camminghub may result in reciprocal axial translation of the pair of barrelsrelative to one another.

The endoscopic stitching device may further include an actuation cabletranslatably and rotatably extending through the lumen defined by thebarrels of the drive assembly. A distal end of the actuation cable maybe operatively connected to the center rod such that rotation of theactuation cable results in rotation of the pair of jaws.

The actuation cable may be translatable to axially translate the centerrod between a first position wherein the jaws are spaced apart from oneanother and a second position wherein the pair of jaws are in a closespaced relation to one another.

The endoscopic stitching device may further include a hollow shaftextending proximally from the camming hub. The actuation cable mayextend through a lumen of the hollow shaft.

The drive assembly may include a pair of axially spaced apart barrels,wherein each barrel may be axially translatable. A distal barrel of thepair of barrels may define an annular groove formed in an outer surfacethereof, and a proximal barrel of the pair of barrels may define anannular groove formed in an outer surface thereof.

Each blade may include a ring supported at a proximal end thereof. Thering of each blade may be rotatably disposed in a respective one of thegrooves formed in the distal and proximal barrels.

The endoscopic stitching device may further include a pair of pusherrods operatively connected, one each, to a respective distal andproximal barrel. In use, axial translation of the pusher rods may resultin corresponding axial translation of a respective distal and proximalbarrel and a respective one of the pair of blades.

The endoscopic stitching device may further include a suture needleoperatively associated with the pair of jaws. The suture needle mayinclude a barbed suture.

According to still another embodiment of the present disclosure, ahandle assembly for operating a surgical instrument is provided. Thehandle assembly includes a housing; a trigger operatively supported onthe housing; and at least one actuation cable operatively connected tothe trigger and extending from the housing in such a manner that anactuation of the trigger imparts axial translation and rotation to theactuation cable.

The handle assembly may further include at least one articulation cableoperable from the housing. Each articulation cable may include a distalend operatively connectable with an end effector and a proximal endoperatively connected to a control element supported on the housing.

The control element may be selected from the group consisting of aslider, a dial, and a lever. In use, movement of the control element mayresult in movement of the at least one articulation cable. Additionally,in use, movement of the at least one articulation cable in a firstdirection may cause an articulation of the end effector in a firstdirection and movement of the at least one articulation cable in asecond direction may result in an articulation of the end effector in asecond direction.

The control element may include a trigger plate defining a gear segmentoperatively engaging at least one gear which is operatively connected toan actuation shaft, and wherein movement of the control element mayresult in at least rotation of the actuation shaft. The control elementmay be operatively connected to the actuation shaft in such a mannerthat movement of the control element may result in axial translation ofthe actuation cable.

According to another aspect of the present disclosure, an endoscopicstitching device is provided including a handle assembly and an endeffector operatively connected to the handle assembly. The handleassembly includes a housing; a trigger operatively supported on thehousing; and an actuation cable operatively connected to the trigger andextending from the housing in such a manner that an actuation of thetrigger imparts axial translation and rotation to the actuation cable.The end effector includes a tool assembly configured and adapted toperform at least a pair of operations. The actuation cable isoperatively connected to the tool assembly in such a manner that theactuation cable is capable of effecting a first operation of the pair ofoperations of the end effector upon the axial translation thereof. Also,the actuation cable is operatively connected to the tool assembly insuch a manner that the actuation cable is capable of effecting a secondoperation of the pair of operations of the end effector upon therotation thereof.

The endoscopic stitching device may further include an articulatableneck assembly interconnecting the handle assembly and the end effector.The neck assembly may be configured and adapted for articulation in atleast one direction transverse to a longitudinal axis thereof.

The endoscopic stitching device may further include a suture needleoperatively associated with the tool assembly. The tool assembly mayinclude a pair of juxtaposed jaws pivotally associated with one another.Each jaw may define a needle receiving recess formed in a tissuecontacting surface thereof.

The endoscopic stitching device may further include an axiallytranslatable needle engaging blade slidably supported in each jaw. Eachblade may include an advanced position wherein a distal end of the bladeengages the suture needle when the suture needle is in the respectivejaw to thereby secure the suture needle therewith, and wherein eachblade includes a retracted position wherein a distal end of the blade isout of engagement with the suture needle.

The pair of blades may be operatively joined to one another so as totranslate in opposite directions relative to one another upon a rotationof the actuation cable. In use, axial, reciprocal translation of theactuation cable may result in opening and closing of the pair of jaws.

The actuation cable may translatably extend between the handle assemblyand the end effector. In use, when the actuation cable is in a firstposition the pair of jaws may be spaced apart from one another, and whenthe actuation cable is in a second position the pair of jaws may be in aclose spaced relation to one another.

The endoscopic stitching device may further include at least onearticulation cable slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly.

The articulation cable may be disposed along an axis spaced a distancefrom a central axis of the neck assembly.

The endoscopic stitching device may further include a camming hub keyedto the actuation cable so as to enable an axial translation of theactuation cable relative to the camming hub, wherein the camming hubrotates upon a rotation of the actuation cable. The camming hub may beoperatively connected to a proximal end of each blade in such a mannerthat rotation of the camming hub results in axial translation of each ofthe pair of blades.

A proximal end of each articulation cable may be operatively connectedto a control element supported on the housing.

The control element of the handle assembly may be selected from thegroup consisting of a slider, a dial, and a lever. In use, movement ofthe control element of the handle assembly may result in movement of theat least one articulation cable. Movement of the at least onearticulation cable in a first direction may cause an articulation of theend effector in a first direction and movement of the at least onearticulation cable in a second direction may result in articulation ofthe end effector in a second direction.

The control element of the handle assembly may include a trigger platedefining a gear segment operatively engaging at least one gear which isoperatively connected to an actuation shaft, wherein movement of thecontrol element may result in at least rotation of the actuation shaft,and wherein the actuation cable may be connected to the actuation shaft.

The control element of the handle assembly may be operatively connectedto the actuation shaft in such a manner that movement of the controlelement may result in axial translation of the actuation cable.

According to a further aspect of the present disclosure, a handleassembly for operating a surgical instrument is provided and includes ahousing; a trigger operatively supported on the housing; and at leastone actuation cable operatively associated with the trigger andextending from the housing in such a manner that an actuation of thetrigger imparts both an axial translation of the actuation cable and arotation to the actuation cable. Each of the axial translation androtation of the actuation cable performs a separate function.

The handle assembly may further include a pair of articulation cablesoperable from the housing. Each articulation cable may include aproximal end operatively connected to a control element supported on thehousing. In use, a first movement of the control element may result inaxial translation of the pair of articulation cables in opposeddirections to one another, and wherein a second movement of the controlelement may result in a reversed axial translation of the pair ofarticulation cables.

The control element may be rotatably supported on the housing.Accordingly, the first movement of the control element may be a rotationof the control element in a first direction; and the second movement ofthe control element may be a rotation of the control element in a seconddirection.

The trigger may include a trigger plate defining a first gear segmentoperatively engagable with a spur gear which is operatively supported onan actuation shaft. In use, actuation of the trigger may result in atleast a rotation of the spur gear and the actuation shaft. The actuationshaft may be coupled to the actuation cable.

The trigger may be operatively connected to the actuation shaft in sucha manner that actuation of the trigger results in axial translation ofthe actuation shaft and actuation cable.

The trigger plate may define a second gear segment operatively engagablewith a gear rack operatively supported on the actuation shaft, whereinactuation of the trigger may result in an axial translation of the gearrack and the actuation shaft.

The handle assembly may further include a follower block rotatablysupported on the actuation shaft and coupled to the gear rack via abiasing element. Accordingly, in use, actuation of the trigger mayresult in axial translation of the gear rack, biasing of the biasingmember and subsequent axial translation of the follower block andactuation shaft.

The spur gear may form a part of a slip clutch which is slidablysupported on the actuation rod. A proximal portion of the slip clutchmay be operatively engaged with the spur gear in such a manner so as toenable unidirectional rotation of the proximal portion upon a rotationof spur gear.

The handle assembly may further include a biasing member configured tomaintain the proximal portion of the slip clutch in engagement with thespur gear. The handle assembly may further include a pawl and whereinthe proximal portion of the slip clutch is configured for engagementwith the pawl in such a manner that the pawl limits the direction ofrotation of the proximal portion of the slip clutch.

According to another aspect of the present disclosure, an endoscopicstitching device is provided including a handle assembly and an endeffector operatively connected to the handle assembly. The handleassembly includes a housing; a trigger operatively supported on thehousing; and at least one actuation cable operatively associated withthe trigger and extending from the housing in such a manner that anactuation of the trigger imparts both an axial translation of theactuation cable and a rotation to the actuation cable. Each of the axialtranslation and rotation of the actuation cable performs a separatefunction. The end effector includes a tool assembly configured andadapted to perform at least a pair of operations. The actuation cable isoperatively connected to the tool assembly in such a manner that theactuation cable is capable of effecting a first operation of the pair ofoperations of the end effector upon the axial translation thereof; andcapable of effecting a second operation of the pair of operations of theend effector upon the rotation thereof.

The endoscopic stitching device may further include an articulatableneck assembly interconnecting the handle assembly and the end effector.The neck assembly may be configured and adapted for articulation in atleast one direction transverse to a longitudinal axis thereof.

The endoscopic stitching device may further include a suture needleoperatively associated with the tool assembly. The tool assembly mayinclude a pair of juxtaposed jaws pivotally associated with one another,and wherein each jaw may define a needle receiving recess formed in atissue contacting surface thereof.

The endoscopic stitching device may further comprise an axiallytranslatable needle engaging blade slidably supported in each jaw. Eachblade may include an advanced position wherein a distal end of the bladeengages the suture needle when the suture needle is in the respectivejaw to thereby secure the suture needle therewith, and wherein eachblade may include a retracted position wherein a distal end of the bladeis out of engagement with the suture needle.

The pair of blades may be operatively joined to one another so as totranslate in opposite directions relative to one another upon a rotationof the actuation cable. In use, axial, reciprocal translation of theactuation cable may result in opening and closing of the pair of jaws.

The actuation cable may translatably extend between the handle assemblyand the end effector. In use, when the actuation cable is in a firstposition the pair of jaws may be spaced apart from one another, and whenthe actuation cable is in a second position the pair of jaws may be in aclose spaced relation to one another.

The endoscopic stitching device may further include at least onearticulation cable slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly. Thearticulation cable may be disposed along an axis spaced a distance froma central axis of the neck assembly.

The endoscopic stitching device may further include a camming hub keyedto the actuation cable so as to enable an axial translation of theactuation cable relative to the camming hub. The camming hub may rotateupon a rotation of the actuation cable. The camming hub may beoperatively connected to a proximal end of each blade in such a mannerthat rotation of the camming hub results in axial translation of each ofthe pair of blades.

The endoscopic stitching device may further include a pair ofarticulation cables operable from the housing. Each articulation cablemay include a proximal end operatively connected to a control elementsupported on the housing. Accordingly, in use, a first movement of thecontrol element may result in axial translation of the pair ofarticulation cables in opposed directions to one another, and a secondmovement of the control element may result in a reversed axialtranslation of the pair of articulation cables.

The control element may be rotatably supported on the housing.Accordingly, in use, the first movement of the control element may be arotation of the control element in a first direction; and the secondmovement of the control element may be a rotation of the control elementin a second direction.

The trigger may include a trigger plate defining a first gear segmentoperatively engagable with a spur gear which is operatively supported onan actuation shaft. Accordingly, in use, actuation of the trigger mayresult in at least a rotation of the spur gear and the actuation shaft,wherein the actuation shaft is coupled to the actuation cable.

The trigger may be operatively connected to the actuation shaft in sucha manner that actuation of the trigger results in axial translation ofthe actuation shaft and actuation cable.

The trigger plate may define a second gear segment operatively engagablewith a gear rack operatively supported on the actuation shaft.Accordingly, in use, actuation of the trigger may result in an axialtranslation of the gear rack and the actuation shaft.

The handle assembly may further include a follower block rotatablysupported on the actuation shaft and coupled to the gear rack via abiasing element. Accordingly, in use, actuation of the trigger mayresult in axial translation of the gear rack, biasing of the biasingmember and subsequent axial translation of the follower block andactuation shaft.

The spur gear may form a part of a slip clutch which is slidablysupported on the actuation rod. A proximal portion of the slip clutchmay be operatively engaged with the spur gear in such a manner so as toenable uni-directional rotation of the proximal portion upon a rotationof spur gear.

The handle assembly may further include a biasing member configured tomaintain the proximal portion of the slip clutch in engagement with thespur gear. The handle assembly may further include a pawl. The proximalportion of the slip clutch may be configured for engagement with thepawl in such a manner that the pawl limits the direction of rotation ofthe proximal portion of the slip clutch.

The handle assembly may further include a spline shaft, co-axiallyaligned with the actuation shaft, and extending from a proximal end ofthe housing, and a knob supported on a proximal end of the spline shaftextending from the proximal end of the housing in such a manner so as totransmit rotation to the spline shaft and to the actuation shaft andactuation cable.

The end effector may further include a thrust bearing disposedproximally of the camming hub in operatively engaged therewith.

According to yet another aspect of the present disclosure, a handleassembly for operating a surgical instrument is provided. The handleassembly includes a housing; a trigger operatively supported on thehousing; and an articulation assembly supported on the housing foreffectuating an articulation of an end effector operatively connected tothe housing. The articulation assembly is operable to effectarticulation of the end effector in a first pair of opposed directionsand a second pair of opposed direction which is substantially transverseto the first pair of opposed directions.

According to a further aspect of the present disclosure, an endoscopicstitching device is provided and includes a handle assembly and an endeffector operatively connected to the handle assembly. The handleassembly includes a housing; a trigger operatively supported on thehousing; and an articulation assembly supported on the housing foreffectuating an articulation of an end effector operatively connected tothe housing. The end effector includes a tool assembly configured andadapted to perform at least a pair of operations. The articulationassembly is connected to the end effector in such a manner thatoperation of the articulation assembly imparts an articulation to theend effector in a first pair of opposed directions and a second pair ofopposed direction which is substantially transverse to the first pair ofopposed directions.

The handle assembly may further include at least one actuation cableoperatively associated with the trigger and extending from the housingin such a manner that an actuation of the trigger imparts both an axialtranslation of the actuation cable and a rotation to the actuationcable. Each of the axial translation and rotation of the actuation cablemay perform a separate function.

The articulation assembly may include a pair of control elementssupported on the housing, wherein each control element may beoperatively connected to a proximal end of pair of articulation cables.

In use, a first movement of a first of the control elements may resultin axial translation of the respective pair of articulation cables inopposed directions to one another. A second movement of the first of thecontrol elements may result in a reversed axial translation of therespective pair of articulation cables. The first of the controlelements may be rotatably supported on the housing. The first movementof the first of the control elements may be a rotation of the first ofthe control elements in a first direction. The second movement of thefirst of the control elements may be a rotation of the first of thecontrol elements in a second direction.

In use, a first movement of a second of the control elements may resultin axial translation of the respective pair of articulation cables inopposed directions to one another. A second movement of the second ofthe control elements may result in a reversed axial translation of therespective pair of articulation cables. The second of the controlelements may be rotatably supported on the housing. The first movementof the second of the control elements may be a rotation of the second ofthe control elements in a first direction. The second movement of thesecond of the control elements may be a rotation of the second of thecontrol elements in a second direction.

The first and second control elements may be co-axially supported on thehousing.

The articulation assembly may further include a gear connected to andcontrolled by each control element, and a pair of gear racks engagedwith the gear of each control element such that rotation of the controlelement results in opposed axial translation of the respective pair ofgear racks. Each pair of articulation cables may be operativelyconnected, one each, to a respective pair of gear racks.

The handle assembly may further include at least one actuation cableoperatively associated with the trigger and extending from the housingin such a manner that an actuation of the trigger imparts both an axialtranslation of the actuation cable and a rotation to the actuationcable, wherein each of the axial translation and rotation of theactuation cable performs a separate function.

The actuation cable may be operatively connected to the tool assembly insuch a manner that the actuation cable is capable of effecting a firstoperation of the pair of operations of the end effector upon the axialtranslation thereof; and wherein the actuation cable is operativelyconnected to the tool assembly in such a manner that the actuation cableis capable of effecting a second operation of the pair of operations ofthe end effector upon the rotation thereof.

According to still another aspect of the present disclosure, anendoscopic stitching device is provided including a handle assemblyincluding a needle loading assembly; an end effector supported on thehandle assembly and configured and adapted to perform at least a pair offunctions; and a single actuation cable operatively connected betweenthe handle assembly and the end effector. The actuation cable is capableof effecting operation of at least the pair of functions, wherein theactuation cable is capable of effecting a first operation of the pair offunctions upon an axial translation thereof; and a second operation ofthe pair of functions upon a rotation thereof, and wherein the actuationcable is rotatable upon a manual actuation of the needle loadingassembly.

The end effector may include a tool assembly operatively supported on adistal end of an articulatable neck assembly. The neck assembly may beconfigured and adapted for articulation in at least one directiontransverse to a longitudinal axis thereof.

The endoscopic stitching device may further include a suture needleoperatively associated with the tool assembly. The tool assembly mayinclude a pair of juxtaposed jaws pivotally associated with one another,and wherein each jaw defines a needle receiving recess formed in atissue contacting surface thereof.

According to a further aspect of the present disclosure, an endoscopicstitching device is provided and includes a handle assembly supporting amanually operated suture needle loading assembly; a tool assemblyoperatively supported on and connected to the handle assembly; a sutureneedle operatively associated with the tool assembly, wherein the toolassembly includes a pair of juxtaposed jaws pivotally associated withone another, and wherein each jaw defines a needle receiving recessformed in a tissue contacting surface thereof; and an actuation cableextending between the handle assembly and the tool assembly, whereinaxial displacement of the actuation shaft results in opening and closingof the jaws and rotation of the actuation cable results in selectiveretention of the suture needle in the jaws. A proximal end of theactuation cable is connected to the suture needle loading assembly suchthat actuation of the suture needle loading assembly imparts rotation tothe actuation cable to selectively engage the suture needle in one ofthe jaws.

The endoscopic stitching device may further include an articulatableneck assembly interconnecting the handle assembly and the tool assembly.The neck assembly may be configured and adapted for articulation in atleast one direction transverse to a longitudinal axis thereof.

The endoscopic stitching device may further include an axiallytranslatable needle engaging blade slidably supported in each jaw andoperatively associated with the actuation cable. Each blade may includean advanced position wherein a distal end of the blade engages thesuture needle when the suture needle is in the respective jaw to therebysecure the suture needle therewith. Each blade may include a retractedposition wherein a distal end of the blade is out of engagement with thesuture needle.

The pair of blades may be operatively joined to one another so as totranslate in opposite directions relative to one another upon a rotationof the actuation cable.

The actuation cable may translatably extend through the neck assemblyand may be operatively connected to the pair of jaws. The actuationcable may include a first position wherein the jaws are spaced apartfrom one another and a second position wherein the pair of jaws are inclose spaced relation to one another.

The suture needle loading assembly may include a knob keyed to theactuation shaft such that rotation of the knob results in rotation ofthe actuation cable and such that the actuation shaft is free to axiallytranslate with respect to the knob. The suture needle loading assemblymay be configured for uni-directional rotation of the knob.

The endoscopic stitching device may further include at least onearticulation cable slidably extending through the neck assembly andhaving a distal end fixedly connected to the tool assembly. Thearticulation cable may be disposed along an axis spaced a distance froma central axis of the neck assembly.

The endoscopic stitching device may further include a camming hubinterconnecting the pair of blades and keyed to a distal end of theactuation shaft so as to enable axial movement of the actuation cablerelative to the camming hub, wherein the camming hub rotates upon arotation of the actuation cable.

The camming hub may be operatively connected to a proximal end of eachblade in such a manner that rotation of the camming hub results in axialtranslation of each of the pair of blades.

According to yet another embodiment of the present disclosure, anendoscopic stitching device is provided and includes a handle assemblydefining a passage therethrough, wherein the passage is configured toselectively accommodate a surgical instrument therein; an end effectorconfigured and adapted to perform at least a pair of functions, the endeffector being operatively connected to the handle assembly; and asingle actuation cable operatively connected to the end effector,wherein the actuation cable is capable of effecting operation of atleast the pair of functions, wherein the actuation cable is capable ofeffecting a first operation of the pair of functions upon an axialtranslation thereof; and a second operation of the pair of functionsupon a rotation thereof.

The endoscopic stitching device may further include a channel extendingsubstantially between the passage of the handle assembly and the endeffector. The channel may be secured to a neck assembly extendingbetween and interconnecting the handle assembly and the end effector.

DETAILED DESCRIPTION OF THE DRAWINGS

The foregoing objects, features and advantages of the disclosure willbecome more apparent from a reading of the following description inconnection with the accompanying drawings, in which:

FIG. 1 is a perspective view of an end effector of a stitching deviceaccording to an embodiment of the present disclosure;

FIG. 2 is an exploded perspective view of the end effector of thestitching device of FIG. 1;

FIG. 3 is an exploded perspective view of a cam mechanism of the endeffector of the stitching device of FIGS. 1 and 2;

FIG. 4 is a longitudinal, cross-sectional view of the end effector ofthe stitching device of FIGS. 1 and 2, illustrating the jaws thereof ina first, open condition;

FIG. 5 is a longitudinal, cross-sectional view of the end effector ofthe stitching device of FIGS. 1 and 2, illustrating the jaws thereof ina second, closed condition;

FIG. 6 is a longitudinal, cross-sectional view of the end effector ofthe stitching device of FIGS. 1 and 2, illustrating the jaws thereof ina third, re-opened condition;

FIG. 7 is a longitudinal, cross-sectional view of the end effector ofthe stitching device of FIGS. 1 and 2, illustrating the distal end in anun-articulated condition;

FIG. 8 is a longitudinal, cross-sectional view of the end effector ofthe stitching device of FIG. 7, illustrating the distal end in anarticulated condition;

FIG. 9 is a perspective view of an end effector of a stitching deviceaccording to another embodiment of the present disclosure;

FIG. 10 is a perspective view of the end effector of FIG. 9, with a jawsupporting member removed therefrom;

FIG. 11 is an enlarged view if the indicated area of detail of FIG. 10;

FIG. 12 is a side, elevational view of a positive clutch of the endeffector of FIGS. 9-11, shown in a first or disconnected condition;

FIG. 13 is an exploded perspective view of the end effector of FIGS.9-12;

FIG. 14 is an exploded perspective view of the positive clutch of theend effector of FIGS. 9-13;

FIG. 15 is a side, elevational view of the positive clutch of the endeffector of FIGS. 9-14, shown in a second or connected condition;

FIG. 16 is a perspective view of the positive clutch of the end effectorof FIGS. 9-15, shown in the second or connected condition;

FIG. 17 is a perspective view of an end effector of a stitching deviceaccording to yet another embodiment of the present disclosure;

FIG. 18 is a perspective view of the end effector of FIG. 17, with a jawsupporting member removed therefrom;

FIG. 19 is a side, elevational view of the end effector of FIGS. 17 and18, with a jaw supporting member removed therefrom;

FIG. 20 is an exploded perspective view of the end effector of FIGS.17-19;

FIG. 21 is a perspective view of a camming hub of the end effector ofFIGS. 17-20;

FIG. 22 is an exploded perspective view of the camming hub of FIG. 21;

FIG. 23 is a plan view of a half of the camming hub of FIGS. 21 and 22;

FIG. 24 is a longitudinal, cross-sectional view of the end effector ofFIGS. 17-23, as taken through a plane that extends longitudinallythrough the jaws of the end effector, illustrating the jaws in an openconfiguration;

FIG. 25 is a longitudinal, cross-sectional view of the end effector ofFIGS. 17-23, as taken through a plane that extends longitudinallybetween the jaws of the end effector, illustrating the jaws in an openconfiguration;

FIG. 26 is a perspective view of the end effector of FIGS. 17-25,illustrating the jaws in a closed configuration;

FIG. 27 is a longitudinal, cross-sectional view of the end effector ofFIGS. 17-26, as taken through a plane that extends longitudinallythrough the jaws of the end effector, illustrating the jaws in theclosed configuration;

FIG. 28 is a longitudinal, cross-sectional view of the end effector ofFIGS. 17-27, as taken through a plane that extends longitudinallybetween the jaws of the end effector, illustrating the jaws in theclosed configuration;

FIG. 29 is a perspective view of the end effector of FIGS. 17-28, withthe jaws and the jaw supporting member removed therefrom, illustrating arotation of a center rod thereof;

FIG. 30 is a perspective view of the end effector of FIGS. 17-28,illustrating a rotation thereof;

FIG. 31 is a perspective view of a neck assembly of an end effectoraccording to another embodiment of the present disclosure;

FIG. 32 is an exploded perspective view of the neck assembly of FIG. 31;

FIG. 33 is a perspective view of a pair of joints of the neck assemblyof FIGS. 31 and 32, shown separated from one another;

FIGS. 34-36 are longitudinal, cross-sectional view, taken through aplane defines by a pair of nubs of the joints, illustrating theconnecting of adjacent joints to one another;

FIG. 37 is a plan view of the neck assembly of FIGS. 31 and 32, shown inan articulated condition;

FIG. 38 is a schematic, perspective illustration of twisted wirearrangement for use in any of the end effectors disclosed herein;

FIG. 39 is a perspective view of an end effector of a stitching deviceaccording to still another embodiment of the present disclosure;

FIG. 40 is an exploded perspective view of the end effector of thestitching device of FIG. 39;

FIG. 41 is a perspective view of an inner drive assembly of the endeffector of FIGS. 39 and 40;

FIG. 42 is a cross-sectional view, as taken though 42-42 of FIG. 41,illustrating a connection of a blade member to an inner barrel of theinner drive assembly of FIG. 41;

FIG. 43 is a cross-sectional view, as taken though 42-42 of FIG. 41,illustrating the blade member and the inner barrel of the inner driveassembly of FIG. 41 connected to one another;

FIG. 44 is a perspective view of an outer drive assembly of the endeffector of FIGS. 39 and 40;

FIG. 45 is a cross-sectional view, as taken though 45-45 of FIG. 44,illustrating a connection of a blade member to an outer barrel of theouter drive assembly of FIG. 44;

FIG. 46 is a cross-sectional view, as taken though 45-45 of FIG. 44,illustrating the blade member and the outer barrel of the outer driveassembly of FIG. 44 connected to one another;

FIG. 47 is a longitudinal, cross-sectional view of the end effector ofFIGS. 39 and 40, illustrating the end effector is a first condition;

FIG. 48 is a longitudinal, cross-sectional view of the end effector ofFIGS. 39 and 40, illustrating the end effector is a second condition;

FIG. 49 is a longitudinal, cross-sectional view of the end effector ofFIGS. 39 and 40, illustrating the end effector is a third condition;

FIG. 50 is a perspective view of a center rod of the end effector ofFIGS. 39 and 40, illustrating an axial rotation thereof;

FIG. 51 is a perspective view of the end effector of FIGS. 39 and 40,illustrating an axial rotation thereof based on the axial rotation ofthe center rod;

FIG. 52 is a longitudinal, cross-sectional view of an end effectoraccording to a further embodiment of the present disclosure, shown in afirst condition;

FIG. 53 is a longitudinal, cross-sectional view of the end effector ofFIG. 52, shown in a second condition;

FIG. 54 is a perspective view, with parts separated, of a drive assemblyof the end effector of FIGS. 52 and 53;

FIG. 55 is a longitudinal, cross-sectional view of the end effector ofFIGS. 52 and 53, shown in a third condition;

FIG. 56 is a longitudinal, cross-sectional view of an end effectoraccording to yet another embodiment of the present disclosure, shown ina first condition;

FIG. 57 is a longitudinal, cross-sectional view of the end effector ofFIG. 56, shown in a second condition;

FIG. 58 is a perspective view, with parts separated, of a drive assemblyof the end effector of FIGS. 56 and 57;

FIG. 59 is a longitudinal, cross-sectional view of the end effector ofFIGS. 56 and 57, shown in a third condition;

FIG. 60 is a schematic illustration of an end effector and driveassembly according to another embodiment of the present disclosure;

FIG. 61 is a schematic illustration of a drive assembly, for an endeffector, according to another embodiment of the present disclosure;

FIG. 62 is a schematic illustration of an end effector according to yetanother embodiment of the present disclosure;

FIG. 63 is a schematic illustration of a closure member according to anembodiment of the present disclosure, for an end effector of the presentdisclosure;

FIG. 64 is a schematic illustration of a drive assembly, for an endeffector, according to yet another embodiment of the present disclosure;

FIGS. 65A-65B are schematic illustrations of an end effector accordingto still another embodiment of the present disclosure;

FIG. 66 is a schematic illustration of a drive assembly, for an endeffector, according to still another embodiment of the presentdisclosure;

FIGS. 67A-67B are schematic illustrations of a drive assembly, for anend effector, according to another embodiment of the present disclosure;

FIGS. 68A-68B are schematic illustrations of a drive assembly, for anend effector, according to another embodiment of the present disclosure;

FIG. 69 is a perspective view of a flexible endoscopic stitching deviceaccording to another embodiment of the present disclosure;

FIG. 70 is a perspective view of an end effector of the endoscopicstitching device of FIG. 69;

FIG. 71 is a longitudinal cross-sectional view of the endoscopicstitching device of FIG. 69;

FIG. 72 is an enlarged view of the indicated area of detail of FIG. 71;

FIG. 73 is an enlarged view of the indicated area of detail of FIG. 71;

FIG. 74 is a left-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a left housing removedtherefrom;

FIG. 75 is a right-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a right housing removedtherefrom;

FIG. 76 is a partial exploded view of the handle assembly of FIGS. 74and 75;

FIG. 77 is a left-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a housing removedtherefrom;

FIG. 78 is a right-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a housing removedtherefrom;

FIG. 79 is a left-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a left housing and a leftframe removed therefrom;

FIG. 80 is a right-side perspective view of the handle assembly of theendoscopic stitching device of FIG. 69, with a right housing and a rightframe removed therefrom;

FIG. 81 is an exploded perspective view of the internal components ofthe handle assembly of the endoscopic stitching device of FIG. 69;

FIG. 82 is an exploded perspective view of the end effector of FIG. 70;

FIG. 83 is an enlarged perspective view of a thrust bearing of the endeffector of FIGS. 70 and 82;

FIG. 84 is an exploded perspective view of the thrust bearing of FIG.83;

FIG. 85 is an exploded perspective view of a cam mechanism of the endeffector of FIGS. 70 and 82;

FIG. 86 is a perspective view of an articulation control mechanism ofthe handle assembly of FIGS. 73-81;

FIG. 87 is a perspective view of a slip-clutch of the handle assembly ofFIGS. 73-81;

FIG. 88 is a cross-sectional view of the articulation control mechanismof FIG. 86 as taken through 88-88 of FIG. 86;

FIG. 89 is a further cross-sectional view of the articulating controlmechanism of FIG. 86, as taken through 88-88 of FIG. 86, illustratingthe operation thereof;

FIG. 90 is a longitudinal, cross-sectional view of the end effector ofthe endoscopic stitching device of FIG. 69, illustrating the distal endin an articulated condition;

FIG. 91 is a side elevational view of a drive mechanism of the handleassembly of FIGS. 73-81, illustrating the drive mechanism and a triggerof the handle assembly being actuated from a first position;

FIG. 92 is a cross-sectional view of the handle assembly of FIGS. 73-81,as taken through 92-92 of FIG. 71, illustrating a first position of auni-directional pawl assembly;

FIG. 93 is a longitudinal, cross-sectional view of the end effector ofthe endoscopic stitching device of FIG. 69, illustrating the jawsthereof in a first, open condition;

FIG. 94 is a longitudinal, cross-sectional view of the end effector ofthe endoscopic stitching device of FIG. 69, illustrating the jawsthereof in a second, closed condition;

FIG. 95 is a side elevational view of the drive mechanism of FIGS.73-81, illustrating the drive mechanism and the trigger of the handleassembly at a second position;

FIG. 96 is a cross-sectional view of the handle assembly of FIGS. 73-81,as taken through 95-95 of FIG. 71, illustrating a second position of theuni-directional pawl assembly;

FIG. 97 is a longitudinal, cross-sectional view of the end effector ofthe endoscopic stitching device of FIG. 69, illustrating the bladesthereof being advance and retracted;

FIG. 98 is a perspective view of the thrust bearing of the end effectorof the endoscopic stitching device of FIG. 69, illustrating theoperation thereof;

FIG. 99 is a side elevational view of the drive mechanism of FIGS.73-81, illustrating the drive mechanism and trigger of the handleassembly in a third position;

FIG. 100 is a side elevational view of the drive mechanism of FIGS.73-81, illustrating the drive mechanism and the trigger of the handleassembly being opened;

FIG. 101 is a cross-sectional view of the handle assembly of FIGS.73-81, as taken through 101-101 of FIG. 71, illustrating a thirdposition of the uni-directional pawl assembly;

FIG. 102 is a perspective view of a handle assembly according to anembodiment of the present disclosure;

FIG. 103 is a perspective view of the handle assembly of FIG. 102, witha half-section of the housing removed therefrom;

FIG. 104 is a side elevational view of the handle assembly of FIG. 103,illustrating a trigger of the handle assembly in a first position;

FIG. 105 is an exploded perspective view of the handle assembly of FIGS.103 and 104;

FIG. 106 is a cross-sectional view of the handle assembly of FIGS.102-105, as taken through 106-106 of FIG. 104;

FIG. 107 is a perspective view of drive assembly of the handle assemblyof FIGS. 102-106;

FIG. 108 is a perspective view of a slide actuator of the handleassembly of FIGS. 102-106;

FIG. 109 is a side elevational view of the handle assembly of FIG. 103,illustrating a trigger of the handle assembly in a second position;

FIG. 110 is a side elevational view of the handle assembly of FIG. 103,illustrating a trigger of the handle assembly in a third position;

FIG. 111 is a perspective view of a handle assembly according to anotherembodiment of the present disclosure;

FIG. 112 is a left-side perspective view of the handle assembly of FIG.111, with a left half-section of the housing removed therefrom;

FIG. 113 is a right-side perspective view of the handle assembly of FIG.111, with a right half-section of the housing removed therefrom;

FIG. 114 is an exploded perspective view of the handle assembly of FIGS.111-113;

FIG. 115 is a perspective view of an articulation control mechanism ofthe handle assembly of FIGS. 111-114;

FIG. 116 is a perspective view of a slip-clutch of the handle assemblyof FIGS. 111-114;

FIG. 117 is a cross-sectional view of the articulation control mechanismof FIG. 115 as taken through 117-117 of FIG. 115;

FIG. 118 is a cross-sectional view of the articulating control mechanismof FIG. 115, as taken through 117-117 of FIG. 115, illustrating theoperation thereof;

FIG. 119 is a cross-sectional view of the handle assembly of FIGS.111-114, as taken through 119-119 of FIG. 112, illustrating a firstposition of a uni-directional pawl assembly;

FIG. 120 is a side elevational view of a drive mechanism of the handleassembly of FIGS. 111-114, illustrating the drive mechanism and atrigger of the handle assembly at a first position;

FIG. 121 is a side elevational view of the drive mechanism of FIG. 120,illustrating the drive mechanism and the trigger of the handle assemblyat a second position;

FIG. 122 is a cross-sectional view of the handle assembly of FIGS.111-114, as taken through 122-122 of FIG. 112, illustrating a secondposition of the uni-directional pawl assembly;

FIG. 123 is a side elevational view of the drive mechanism of FIG. 120,illustrating the drive mechanism and trigger of the handle assembly in athird position;

FIG. 124 is a side elevational view of the drive mechanism of FIG. 120,illustrating the drive mechanism and the trigger of the handle assemblyin a fourth position;

FIG. 125 is a cross-sectional view of the handle assembly of FIGS.111-114, as taken through 125-125 of FIG. 112, illustrating a thirdposition of the uni-directional pawl assembly;

FIG. 126 is a schematic illustration of a suture for use in combinationwith the stitching devices of the present disclosure;

FIG. 127 is a perspective view of a handle assembly according to anotherembodiment of the present disclosure;

FIG. 128 is an exploded perspective view of the handle assembly of FIG.127;

FIG. 129 is an exploded perspective view of an articulation assembly ofthe handle assembly of FIGS. 127 and 128;

FIG. 130 is an exploded perspective view of a manual needle switchingmechanism of the handle assembly of FIGS. 127-129;

FIG. 131 is a perspective view of the handle assembly of FIGS. 127-130,illustrated with a housing half-section removed therefrom;

FIG. 132 is a longitudinal, cross-sectional view of the handle assemblyof FIGS. 127-131;

FIG. 133 is a perspective view of a handle assembly according to yetanother embodiment of the present disclosure;

FIG. 134 is an exploded perspective view of the handle assembly of FIG.133;

FIG. 135 is an exploded perspective view of an articulation assembly ofthe handle assembly of FIGS. 133 and 134;

FIG. 136 is an exploded perspective view of a manual needle switchingmechanism of the handle assembly of FIGS. 133-135;

FIG. 137 is a perspective view of the handle assembly of FIGS. 133-136,illustrated with a housing half-section removed therefrom;

FIG. 138 is a perspective view of the handle assembly of FIGS. 133-137,illustrated with the housing half-section and a side plate of thearticulation assembly removed therefrom;

FIG. 139 is a perspective view of the handle assembly of FIGS. 133-138,illustrated with the housing half-section, the side plate and a ratchetwheel of the articulation assembly removed therefrom;

FIG. 140 is a perspective view of the handle assembly of FIGS. 133-139,illustrated with the housing half-section, the side plate, the ratchetwheel and a support member of the articulation assembly removedtherefrom;

FIG. 141 is a perspective view of the handle assembly of FIGS. 133-140,illustrated with the housing half-section and the articulation assemblyremoved therefrom; and

FIG. 142 is a longitudinal, cross-sectional view of the handle assemblyof FIGS. 133-141.

DETAILED DESCRIPTION OF EMBODIMENTS

The present disclosure relates to devices, systems and methods forendoscopic, laparoscopic, endoluminal, and/or transluminal suturing. Inone embodiment, for example, such a device comprises a handle, handleassembly or other suitable actuating mechanism (e.g., robot, etc.)connected to a proximal end of a flexible, elongated body portion. Aneck assembly operatively supported on a distal end of the flexible,elongated body portion allows an end effector, operatively supported ata distal end of the neck assembly, to articulate in response toactuation of articulation cables. The end effector includes a sutureneedle and a pair of jaws. In operation, the suture needle is passedback and forth through tissue from one jaw to the other. The device isadapted to be placed in a lumen of a flexible endoscope and theninserted into a natural orifice of a patient and transited endoluminallythrough the anatomy of the natural lumen to a treatment site within oroutside the natural lumen.

In the drawings and in the description which follow, the term“proximal”, as is traditional, will refer to the end of the device whichis closest to the operator, while the term “distal” will refer to theend of the device which is furthest from the operator.

Referring now in specific detail to the drawings, in which likereference numbers identify similar or identical elements, FIGS. 1-3illustrate one embodiment of an end effector of a stitching device,shown generally at 100. End effector 100 of the stitching device isadapted to be particularly useful in endoscopic or laparoscopicprocedures wherein an endoscopic portion of the stitching device, i.e.,end effector 100, is insertable into an operative site, via a cannulaassembly or the like (not shown).

As seen in FIGS. 1-3, end effector 100 of the stitching device issupportable on or extends from a handle assembly (not shown) and/or adistal end of an elongate tubular body portion (not shown) extendingdistally from the handle assembly and defining a longitudinal axis and alumen therethrough. End effector 100 may be operatively associated withor supported on a distal end of elongate body portion and may beremotely operable by the handle assembly.

End effector 100 includes a neck assembly 110 supported on a distal endof a shaft extending from a handle assembly, and a tool assembly 120supported on a distal end of neck assembly 110. Neck assembly 110includes a plurality of joints 112 each including a distal knuckle 112 aand a proximal clevis 112 b formed therewith. Each knuckle 112 aoperatively engages a clevis 112 b of an adjacent joint 112. Each joint112 defines a central lumen 112 c formed therein and a pair of opposedlumen 112 d, 112 e formed on either side of central lumen 112 c. A pairof articulation cables 114 a, 114 b slidably extend through respectivelumens 112 d, 112 e of joints 112. Operation of neck assembly 110 toarticulate end effector 100 thereabout, will be discussed in greaterdetail below.

As seen in FIGS. 1-3, tool assembly 120 of end effector 100 includes ajaw support member 122, and a pair of jaws 130, 132 mounted forpivotable movement on jaw support member 122. Jaw support member 122defines a lumen 124 in a proximal end thereof and a pair of spaced apartarms 126 in a distal end thereof. Lumen 124 is configured anddimensioned to receive a stem 112 f extending from a distal-most joint112 of neck portion 110. Lumen 124 defines a pair of opposed channels124 a, 124 b in a surface thereof.

Each jaw 130, 132 includes a needle receiving recess 130 a, 132 a,respectively, configured to surround and hold at least a portion of asurgical needle 104 disposed therein substantially perpendicular totissue engaging surfaces thereof. As seen in FIG. 2, needle 104 includesa groove 104 a formed near each end thereof. A suture (not shown) may besecured to surgical needle 104 at a location between grooves 104 a.

Suture of surgical needle 104 may comprise a one-way or barbed suture,wherein the suture includes an elongated body having a plurality ofbarbs extending therefrom. The barbs are oriented in such a way that thebarbs cause the suture to resist movement in an opposite directionrelative to the direction in which the barb faces.

Suitable sutures for use with surgical needle 104 include, and are notlimited to, those sutures described and disclosed in U.S. Pat. No.3,123,077; U.S. Pat. No. 5,931,855; and U.S. Patent Publication No.2004/0060409, filed on Sep. 30, 2002, the entire content of each ofwhich being incorporated herein by reference.

Jaws 130, 132 are pivotably mounted on support member 122 by means of ajaw pivot pin 134 which extend through holes 126 a formed in arms 126 ofsupport member 122 and respective pivot holes 130 b, 132 b formed injaws 130, 132. To move jaws 130, 132 between an open position and aclosed position there is provided an axially or longitudinally movablecenter rod 136 having a camming pin 138 mounted at a distal end 136 athereof. Camming pin 138 rides in and engages angled camming slots 130c, 132 c formed in respective jaws 130, 132 such that axial orlongitudinal movement of center rod 136 causes jaws 130, 132 to becammed between open and closed positions.

Tool assembly 120 includes a keyed rod 140 having a distal end 140 arotatably connected to a proximal end 136 b of center rod 136. Keyed rod140 includes a proximal end 140 b fixedly connected to a distal end ofan actuation cable 142, and a body portion 140 c, disposed betweendistal end 140 a and proximal end 140 b, having a non-circularcross-sectional profile.

Tool assembly 120 further includes a camming hub 144 defining a lumen144 a therethrough configured and adapted to slidably receive bodyportion 140 c of keyed rod 140 therein. Camming hub 144 defines ahelical or spiral groove 144 b in an outer surface thereof. Camming hub144 is configured for rotatable disposition within lumen 124 of supportmember 122.

In operation, rotation of actuation cable 142 imparts rotation to keyedrod 140 which, in turn, imparts rotation to camming hub 144. However,since keyed rod 140 is rotatably connected to center rod 136, norotation is imparted thereto. Also, axial displacement of actuationcable 142 imparts axial displacement to keyed rod 140 which, in turn,imparts axial displacement to center rod 136. However, since camming hub144 is axially slidably supported on keyed rod 140, no axialdisplacement is imparted thereto.

Tool assembly 120 further includes a pair of needle engaging members orblades 150, 152 which are slidably supported within respective channels124 a, 124 b of support member 122. Each blade 150, 152 includes adistal end 150 a, 152 a slidably extending into blade receiving channels130 d, 132 d (see FIGS. 4-5) of respective jaws 130, 132. Channels 130d, 132 d are dimensioned and configured so as to at least partiallyintersect needle recesses 130 a, 132 a. Thus, by advancing blade 150 or152 within respective channel 130 d, 132 d, a distal end 150 a, 152 a ofthe advancing blade 150 or 152 engages or “locks in” a groove 104 aformed in needle 104 disposed within the respective recess 130 a, 132 a.Each blade 150, 152 includes a proximal end 150 b, 152 b slidablydisposed within groove 144 b of camming hub 144. In operation, ascamming hub 144 is rotated, proximal ends 150 b, 152 b of blades 150,152 ride within groove 144 b of camming hub 144 and are moved in anaxial direction relative thereto. In particular, upon rotation ofcamming hub 144, as blade 150 is moved distally, blade 152 is movedproximally and vise-versa.

Turning now to FIGS. 4-6, a method of operating end effector 100 isshown and described. As seen in FIG. 4, needle 104 is held within recess130 a by distal end 150 a of blade 150 engaging a groove 104 a of needle104. Additionally, as seen in FIG. 4, jaws 130, 132 are maintained in anopen position by having center rod 136 at a distal-most position which,in turn, positions camming pin 138 at a distal-most end of camming slots130 c, 132 c.

Turning now to FIG. 5, in order to approximate jaws 130, 132, actuationcable 142 is moved in a proximal direction, as indicated by arrow “A”,thereby moving keyed rod 140 and, in turn, center rod 136 in a proximaldirection. In so doing, camming pin 138 rides proximally through cammingslots 130 c, 132 b of jaws 130, 132 thus causing jaws to pivot aboutpivot pin 134 and, in turn, cause distal ends of jaws 130, 132 toapproximate towards one another, as indicated by arrows “B”. In sodoing, a free end of needle 104 is moved into recess 132 a of jaw 132.If tissue were present between the distal ends of jaws 130, 132, thefree end of needle 104 would penetrate through the tissue prior to theentrance into recess 132 a of jaw 132.

Turning now to FIG. 6, in order to release needle 104 from jaw 130 andsecure or lock needle 104 in jaw 132, actuation cable 142 is rotated inthe direction of arrow “C”, thereby imparting rotation to keyed rod 140which, in turn, imparts rotation to camming hub 144. As camming hub 144is rotated in the direction of arrow “C”, proximal ends 150 b, 152 b ofblades 150, 152 ride along or through groove 144 b. In particular, asseen in FIG. 6, as camming hub 144 is rotated in the direction of arrow“C”, blade 150 is moved in a proximal direction (as indicated by arrow“A”) while blade 152 is moved in a distal direction (as indicated byarrow “A1”). In so doing, distal end 150 a of blade 150 disengagesgroove 104 a of needle 104 disposed within recess 130 a of jaw 130, anddistal end 152 b of blade 152 engages groove 104 a of needle 104disposed within recess 132 a of jaw 132. As such, needle 104 is securedor locked within recess 132 a of jaw 132.

Turning now to FIGS. 7 and 8, a method of articulating end effector 100is shown and described. As seen in FIG. 7, with end effector 100 in anaxially aligned condition, in order to articulate end effector 100 aboutneck assembly 110, a first articulation 114 b (i.e., the lowerarticulation cable as depicted in FIGS. 7 and 8) is withdrawn in aproximal direction, as indicated by arrow “D” of FIG. 8. As articulationcable 114 b is drawn in a proximal direction, a distal end ofarticulation cable 114 b, anchored to a distal-most joint 112, at alocation spaced a distance from a central axis thereof, joints 112 torotate about the interface between knuckles 112 a and clevis' 112 bthereby causing gaps defined therebetween, along a side surface thereof,to constrict. In so doing, end effector 100 is articulated along neckassembly 110 to displace tool assembly 120 in a downward direction, inthe direction of arrow “E” (as depicted in FIG. 8), i.e., in a directiontransverse to a longitudinal axis thereof.

In order to return end effector 100 to an un-articulated condition or toarticulate end effector in an opposite direction, articulation cable 114a (i.e., the upper articulation cable as depicted in FIGS. 7 and 8) iswithdrawn in a proximal direction.

Turning now to FIGS. 9-16, an end effector, according to anotherembodiment of the present disclosure, is generally designated as endeffector 200. End effector 200 is substantially similar to end effector100 and thus will only be described herein to the extent necessary toidentify differences in construction and operation thereof. Throughoutthe following disclosure, like reference numeral will be used toidentify like elements.

As seen in FIGS. 9-14, end effector 200 includes a tool assembly 220supported on an end of a neck assembly (not shown). Tool assembly 220includes a jaw support member 222, and a pair of jaws 230, 232 mountedfor pivotable movement on jaw support member 222. As seen in FIG. 13,jaw support member 222 defines a lumen 224 in a proximal end thereof anda pair of spaced apart arms 226 in a distal end thereof. Lumen 224defines a pair of opposed channels 224 a formed in a surface thereof(only one being shown).

Each jaw 230, 232 is substantially similar to jaws 130, 132 describedabove in regard to end effector 100 and thus the construction of jaws230, 232 will not be discussed in further detail herein below.

Jaws 230, 232 are pivotably mounted on support member 222 by means of ajaw pivot pin 234 which extend through holes 226 a formed in arms 226 ofsupport member 222 and respective pivot holes formed in jaws. To movejaws 230, 232 between an open position and a closed position there isprovided an axially or longitudinally movable center rod 236 having acamming pin 238 mounted at a distal end thereof. Camming pin 238 ridesin and engages angled camming slots formed in respective jaws 230, 232such that axial or longitudinal movement of center rod 236 causes jaws230, 232 to be cammed between open and closed positions.

Tool assembly 220 includes a keyed block 240 slidably disposed withinlumen 224 of support member 222. Keyed block 240 includes a pair ofopposed flattened outer surfaces 240 a, and a pair of opposed axial ribs240 b projecting from an outer surface thereof. Keyed block 240 furtherincludes a lumen 240 c extending therethrough and a pair of opposedaxially extending grooves 240 d formed in a wall of lumen 240 c. Grooves240 d may be aligned with or in registration with ribs 240 b. Ribs 240 bare configured for slidable receipt in channels 224 a formed in lumen224 of support member 222.

Tool assembly 220 further includes a clevis 242 disposed distally ofkeyed block 240. Clevis 242 includes a pair of spaced apart arms 242 bextending from a base 242 a. Each arm 242 b defines a lumen 242 ctherethrough. Clevis 242 defines a central aperture 242 d formed in base242 a. Arms 242 b are spaced apart an amount sufficient and centralaperture 242 d of base 242 b is dimensioned so as to slidably androtatably receive center rod 236 therein.

Tool assembly 220 further includes a camming hub 244 defining a lumen244 a therethrough configured and adapted to slidably receive a portionof center rod 236 therein. Camming hub 244 defines a substantiallyhelical or spiral groove 244 b in an outer surface thereof. A distal anda proximal end 244 c of helical groove 244 b may be flattened or may beconfigured to extend or run parallel to a plane oriented orthogonal to alongitudinal axis thereof.

Camming hub 244 is configured for rotatable disposition within lumen 224of support member 222. In particular, camming hub 244 may include anouter circumferential groove 244 d formed therein for slidableengagement with a nub, boss or the like (not shown) projecting inwardlyfrom support member 222. In this manner, the axial location of camminghub 244 is fixed with respect to support member 222.

Camming hub 244 includes a first clutch portion 246 a provided or formedat a proximal end thereof, wherein lumen 244 a of camming hub 244extends through first clutch portion 246 a. Tool assembly 220 furtherincludes a second clutch portion 246 b supported on a distal end of ahollow shaft 248. Second clutch portion 246 b defines a central lumen246 b′ therethrough. Each of first and second clutch portions 246 a, 246b includes or defines complementary inter-engaging structure, elementsor formations 247 a, 247 b provided on opposed surfaces thereof.

In operation, as will be discussed in greater detail below, secondclutch portion 246 b is translatable relative to first clutch portion246 a, via hollow shaft 248, in order to selectively engage anddisengage inter-engaging elements 247 a, 247 b with one another. Wheninter-engaging elements 247 a, 247 b are engaged with one another,rotation of hollow shaft 248 will rotate second clutch portion 246 b,which will in turn rotate camming hub 244 via second clutch portion 246b. When inter-engaging elements 247 a, 247 b are disengaged from oneanother, rotation of hollow shaft 248 will rotate second clutch portion246 b, however, no rotation will be imparted to camming hub 244. Also,when inter-engaging elements 247 a, 247 b are disengaged from oneanother, rotation of central shaft 237, extending from center rod 236and through clevis 242, keyed block 240, camming hub 244, second clutchportion 246 b and hollow shaft 248, will result in rotation of jaws 230,232 without an axial movement of blades 250, 252.

Tool assembly 220 further includes a pair of needle engaging members orblades 250, 252 which are slidably supported within a respective lumen242 c of arms 242 b of clevis 342 and through respective grooves 240 dof keyed block 240.

Each blade 250, 252 includes a distal end 250 a, 252 a slidablyextending into blade receiving channels 230 d, 232 d (see FIG. 13) ofrespective jaws 230, 232. Each blade 250, 252 includes a proximal end250 b, 252 b slidably disposed within groove 244 b of camming hub 244.In operation, as camming hub 244 is rotated, proximal ends 250 b, 252 bof blades 250, 252 ride within groove 244 b of camming hub 244 and aretranslated, in an axial direction, relative thereto. In particular, uponrotation of camming hub 244, as blade 250 is moved distally, blade 252is moved proximally and vise-versa.

Turning now to FIGS. 10-12 and 14-16, a method of operating end effector200 is shown and described. As seen in FIGS. 10-12, when first andsecond clutch portions 246 a, 246 b are axially spaced from one anotheror are disengaged from one another, jaws 230, 232 are free to rotateabout a longitudinal axis thereof without effectuating axial translationof blades 250, 252. In particular, when first and second clutch portions246 a, 246 b are axially spaced from one another or are disengaged fromone another, rotation of second clutch portion 246 b, via hollow shaft248, does not transmit any rotation to first clutch portion 246 a and,in turn, to jaws 230, 232, i.e., jaws 230, 232 remain stationary.Moreover, as central shaft 237 is rotated about a longitudinal axisthereof, center rod 236 to rotate which in turn causes jaws 230, 232 torotate about the longitudinal axis.

As seen in FIGS. 14-16, when first and second clutch portions 246 a, 246b engaged with one another, jaws 230, 232 may not be rotated about thelongitudinal axis thereof without effectuating axial translation ofblades 250, 252. In particular, when first and second clutch portions246 a, 246 b are engaged with one another, rotation of second clutchportion 246 b in the direction of arrow “A”, via hollow shaft 248,transmits a rotation to first clutch portion 246 a and, in turn, tocamming hub 244.

As camming hub 244 is rotated, proximal ends 250 b, 252 b of blades 250,252 ride within groove 244 b of camming hub 244 and are translated, inan axial direction, relative thereto. In particular, upon rotation ofcamming hub 244, as blade 250 is moved distally, blade 252 is movedproximally and vise-versa.

Similar to end effector 100, in order to open or close jaws 230, 232, ofend effector 200, central shaft or cable 248 is translated in an axialdirection, thereby moving center rod 236 to move camming pin 238.Camming pin 238 rides through the camming slots of jaws 230, 232 thuscausing jaws to pivot about pivot pin 234 and cause distal ends of jaws230, 232 to open or close.

Turning now to FIGS. 17-30, an end effector, according to yet anotherembodiment of the present disclosure, is generally designated endeffector 300. End effector 300 is substantially similar to end effector200 and thus will only be described herein to the extent necessary toidentify differences in construction and operation thereof. Throughoutthe following disclosure, like reference numeral will be used toidentify like elements.

As seen in FIGS. 17-30, end effector 300 includes a tool assembly 320supported on an end of a neck assembly (not shown). Tool assembly 320includes a jaw support member 322, and a pair of jaws 330, 332 mountedfor pivotable movement on jaw support member 322. As seen in FIG. 20,jaw support member 322 defines a lumen 324 in a proximal end thereof anda pair of spaced apart arms 326 in a distal end thereof. Lumen 324defines a pair of opposed channels 324 a formed in a surface thereof(only one being shown).

Each jaw 330, 332 is substantially similar to jaws 230, 232 describedabove in regard to end effector 200 and thus the construction of jaws330, 332 will not be discussed in further detail herein below.

Jaws 330, 332 are pivotably mounted on support member 322 by means of ajaw pivot pin 334 which extend through holes 326 a formed in arms 326 ofsupport member 322 and respective pivot holes formed in jaws. To movejaws 330, 332 between an open position and a closed position there isprovided an axially or longitudinally movable center rod 336 having acamming pin 338 mounted at a distal end thereof. Camming pin 338 ridesin and engages angled camming slots formed in respective jaws 330, 332such that axial or longitudinal movement of center rod 336 causes jaws330, 332 to be cammed between open and closed positions.

Tool assembly 320 includes a keyed block 340 and a clevis 342. Keyedblock 340 and a clevis 342 are substantially similar to keyed block 240and a clevis 242 and thus the construction of keyed block 340 and aclevis 342 will not be discussed in further detail herein below.

Tool assembly 320 further includes a camming hub 344 defining a lumen344 a therethrough configured and adapted to slidably receive a portionof center rod 336 therein. Camming hub 344 defines a substantiallyhelical or spiral groove 344 b in an outer surface thereof. A distal anda proximal end 344 c of helical groove 344 b may be flattened or may beconfigured to extend or run parallel to a plane oriented orthogonal to alongitudinal axis thereof.

Camming hub 344 is configured for rotatable disposition within lumen 324of support member 322. In particular, camming hub 344 may include anouter circumferential groove 344 d formed therein for slidableengagement with a nub, boss or the like 345 (see FIG. 24) projectinginwardly from support member 322. In this manner, the axial location ofcamming hub 344 is fixed with respect to support member 322.

As seen in FIGS. 20-25 and 27-28, camming hub 344 includes a pair ofspaced apart helical grooves 344 e, 344 f formed in a surface of lumen344 a, and a pair of opposed axially oriented grooves 344 g formed in asurface of lumen 344 a and interconnecting helical grooves thereof 344e, 344 f.

With continued reference to FIGS. 20-25 and 27-28, a cam pin 339 isprovided with extending transversely through camming rod 336 and whichis dimensioned for slidable inter-engagement in internal helical grooves344 e, 344 f and internal axial grooves 344 g of camming hub 344.

Tool assembly 320 further includes a pair of needle engaging members orblades 350, 352 which are operatively associated with clevis 342 andkeyed block 340 in a manner substantially similar to blades 250, 252with clevis 242 and keyed block 240. Blades 350, 352 are substantiallysimilar to blades 250, 252 and thus the construction of blades 350, 352will not be discussed in further detail herein below.

Turning now to FIGS. 24-25 and 27-30, a method of operating end effector300 is shown and described. As seen in FIGS. 24-25, when camming pin 339is at a distal-most position in internal axial grooves 344 g of camminghub 344, center rod 336 is at a distal-most portion and jaws 330, 332are spaced apart from one another. As seen in FIGS. 29 and 30, whilecamming pin 339 is in the distal-most position of internal axial groove344 g of camming hub 344, rotation of center rod 336 transmits arotational force to camming pin 338 which, in turn causes tool assembly320 to rotate about the longitudinal axis while jaws 330, 332 areopened. Concomitantly therewith, as center rod 336 is rotated, arotational force is transmitted to camming pin 339, however, sincecamming hub 334 is journaled in support member 332, camming hub 344 isprevented from translational movement and thus merely rotates with therotation of jaws 330, 332.

In one configuration, as center rod 336 and camming pin 339 are movedproximally, camming pin 339 operatively engages against inner helicalgrooves 344 e, 344 f to create a rotation of camming hub 344. As camminghub 344 is rotated, the proximal ends of blades 350, 352 ride withinouter helical groove 344 b of camming hub 344 and are translated, in anaxial direction, relative thereto. In particular, upon rotation ofcamming hub 344, as blade 350 is moved distally, blade 352 is movedproximally and vise-versa.

In another configuration, as center rod 336 and camming pin 339 aremoved proximally, camming pin 339 merely translates through inner axialgroove 344 g of camming hub 344. In so doing, no rotation or translationis transmitted to camming hub 344.

While camming rod 336 is moved proximally, camming pin 338 urges jaws330, 332 to an approximated position.

Additionally, as seen in FIGS. 26-28, when camming pin 339 is at aproximal-most position in internal axial grooves 344 g of camming hub344, center rod 336 is at a proximal-most portion and jaws 330, 332 areapproximated towards one another.

While camming pin 339 is in the proximal-most position of internal axialgroove 344 g of camming hub 344, rotation of center rod 336 transmits arotational force to camming pin 338 which, in turn causes tool assembly320 to rotate about the longitudinal axis while jaws 330, 332 are in theapproximated position. Concomitantly therewith, as center rod 336 isrotated, a rotational force is transmitted to camming pin 339, however,since camming hub 334 is journaled in support member 332, camming hub344 is prevented from translational movement and thus merely rotateswith the rotation of tool assembly 320.

In one configuration, as center rod 336 and camming pin 339 are moveddistally, camming pin 339 operatively engages against inner helicalgrooves 344 e, 344 f to create a rotation of camming hub 344. As camminghub 344 is rotated, the proximal ends of blades 350, 352 ride withinouter helical groove 344 b of camming hub 344 and are translated, in anaxial direction, relative thereto. In particular, upon rotation ofcamming hub 344, as blade 350 is moved distally, blade 352 is movedproximally and vise-versa.

In another configuration, as center rod 336 and camming pin 339 aremoved distally, camming pin 339 merely translates through inner axialgroove 344 g of camming hub 344. In so doing, no rotation or translationis transmitted to camming hub 344.

In an embodiment, inner axial groove 344 g may include structure whichprevents camming pin 339 from moving in both a distal and a proximaldirection. In particular, inner axial groove 344 g may include aramp-like structure or the like formed therein which allows for cammingpin 339 to move only in a first direction, i.e., either distally orproximally, and not a second direction, opposite to the first direction.

As seen in FIGS. 17 and 30, end effector 300 is configured for rotationabout a longitudinal axis of a neck assembly 310, as indicated bydouble-headed arrow “A”; for pivotal movement of tool assembly 320relative to neck assembly 310, as indicated by double-headed arrow “B”;and tool assembly 320 is configured for rotation about a longitudinalaxis thereof, as indicated by double-headed arrow “C”.

Turning now to FIGS. 31-37, a neck assembly, according to anotherembodiment of the present disclosure, is generally designated neckassembly 210. Neck assembly 210 is substantially similar to neckassembly 110 and thus will only be described herein to the extentnecessary to identify differences in construction and operation thereof.Throughout the following disclosure, like reference numeral will be usedto identify like elements.

As seen in FIGS. 31-37, neck assembly 210 is configured for support on adistal end of a shaft extending from a handle assembly (not shown) andfor supporting a jaws support member 122, 222 of a tool assembly at adistal end thereof.

Neck assembly 210 includes a plurality of joints 212 each including adistal knuckle 212 a extending from a proximal housing 212 b. Eachknuckle 212 a operatively engages a proximal housing 212 b of anadjacent joint 212. Each joint 212 defines a central lumen 212 c formedtherein and a pair of opposed lumens 212 d, 212 e formed on either sideof central lumen 212 c. A pair of articulation cables (not shown)slidably extend through respective lumens 212 d, 212 e of joints 212.

Each joint 212 further includes a pair of opposed nubs 212 f extendingfrom opposed side surfaces of distal knuckle 212 a. Nubs 212 f define apivot axis “B” extending therethrough. Each nub 212 f is configured forselective receipt in a respective complementarily configured aperture212 g formed in proximal housing 212 b.

In use, adjacent joints 212 may be pivotally connected to one another intip-to-tail fashion such that distal knuckles 212 a are received withinproximal housing 212 b and, more particularly, nubs 212 f of distalknuckles 212 a are operatively received within apertures 212 g ofproximal housing 212 b. As seen in FIGS. 33-36, when adjacent joints 212are joined to one another, during interconnection thereof, distalknuckle 212 a is flexed or biased such that nubs 212 f thereof areapproximated toward one another see FIG. 35) as distal knuckle 212 a isadvanced into proximal housing 212 b until nubs 212 f are inregistration with or are received in apertures 212 g. When nubs 212 fare so positioned, distal knuckle 212 a is un-biased so as to fit nubs212 f into apertures 212 g (see FIG. 36).

As seen in FIG. 37, with a plurality of joints 212 connected to oneanother, neck assembly 210 may be shaped in an arcuate configuration asneeded. While joints 212 are shown as being connected to one anothersuch that the pivot axes “B” thereof are all substantially parallel toone another, it is envisioned and contemplated that the pivot axes “B”thereof may be at any angle or inclination relative to one another,thereby allowing for neck assembly 210 to deflect in any directionrelative to a longitudinal axis thereof.

As seen in FIG. 32, a distal-most joint 213 of neck assembly 210 may beconfigured to connection to jaw support member 122, 222. In particular,distal-most joint 213 includes a distal housing 213 a extending from aproximal housing 213 b. Proximal housing 213 b of distal-most joint 213is configured for pivotal connection with distal knuckle 212 a of joint212.

Distal-most joint 213 defines a central lumen 213 c formed therein and apair of opposed lumens 213 d, 213 e formed on either side of centrallumen 213 c. Central lumen 213 c and opposed lumens 213 d, 213 e ofdistal-most joint 213 are disposed in a plane which is substantiallyorthogonal to a plane defined by central lumen 212 c and opposed lumens212 d, 212 e of joint 212.

In order to articulate any of the end effectors about neck assembly 210a first articulation (not shown), extending through lumens 212 d ofjoints 212 may be withdrawn in a proximal direction. As the firstarticulation cable is drawn in a proximal direction, a distal end of thefirst articulation cable, anchored to support member 122, 222, at alocation spaced a distance from a central axis thereof, causes joints212 to pivot about pivot axes “B” thereof, thereby causing gaps definedbetween adjacent joints 212 to constrict. In so doing, the end effectoris articulated along neck assembly 210 to displace support member 122,222 in a first direction. In order to return the end effector to anun-articulated condition or to articulate the end effector in anopposite direction, a second articulation cable (not shown), extendingthrough lumens 212 e of joints 212 may be withdrawn in a proximaldirection.

Turning now to FIG. 38, a twisted wire arrangement for incorporationinto any of the end effectors disclosed herein, is shown. As seen inFIG. 38, a central actuation cable 242 extends substantiallylongitudinally along a central axis of end effector 100, 200. A pair ofopposed actuation cables 214 a, 214 b extend along opposed sides ofcentral actuation cable 242. Proximal ends 214 a′, 214 b′ of eachopposed actuation cable 214 a, 214 b define a first plane, while distalends 214 a″, 214 b″ of each opposed actuation cable 214 a, 214 b definea second plane that is oriented at an angle with respect to the firstplane, preferably oriented orthogonally with respect to the first plane.In other words, opposed actuation cables 214 a, 214 b wrap aroundcentral actuation cable 242 approximately 90° from a proximal endthereof to a distal end thereof.

In use, for example, proximal ends 214 a′, 214 b′ of opposed actuationcables 214 a, 214 b may extend through respective lumens 212 d, 212 e ofjoints 212 (see FIG. 32) and twist around central actuation cable 242while passing through distal-most joint 213 such that distal ends 214a″, 214 b″ enter opposed lumens 213 d, 213 e, respectively (see FIG.32).

Alternatively, the end effector may be provided with a segment whereineach actuation cable 214 a, 214 b, 242 is un-guided (i.e., does not passthrough a lumen or the like). In this manner, opposed actuation cables214 a, 214 b may be wrapped around central actuation cable 242 by atleast about 0°-180° in a clockwise and counter-clockwise direction,preferably about 90° in a clockwise and counter-clockwise direction.

It is contemplated that each actuation cable 214 a, 214 b, 242 isconstructed from a flexible material capable of transmitting torsionalforces and which is substantially incompressible and inextendable. Eachactuation cable 214 a, 214 b, 242 may be constructed from stainlesssteel or any other material suitable for the intended purpose oftransmitting torsional forces along a length thereof.

Turning now to FIGS. 39-51, an end effector, according to anotherembodiment of the present disclosure, is generally designated as endeffector 400. End effector 400 is substantially similar to end effector200 and thus will only be described herein to the extent necessary toidentify differences in construction and operation thereof. Throughoutthe following disclosure, like reference numeral will be used toidentify like elements.

As seen in FIGS. 39-51, end effector 400 includes a tool assembly 420supported on an end of a neck assembly 410. Tool assembly 420 includes ajaw support member 422, and a pair of jaws 430, 432 mounted forpivotable movement on jaw support member 422. As seen in FIG. 40, jawsupport member 422 defines a lumen 424 in a proximal end thereof and apair of spaced apart arms 426 in a distal end thereof.

Each jaw 430, 432 is substantially similar to jaws 130, 132 describedabove in regard to end effector 100 and thus the construction of jaws430, 432 will not be discussed in further detail herein below.

Jaws 430, 432 are pivotably mounted on support member 422 by means of ajaw pivot pin 434 which extend through holes 426 a formed in arms 426 ofsupport member 422 and respective pivot holes formed in jaws 430, 432.To move jaws 430, 432 between an open position and a closed positionthere is provided an axially or longitudinally movable center rod 436having a camming pin 438 mounted at a distal end thereof. Camming pin438 rides in and engages angled camming slots formed in respective jaws430, 432 such that axial or longitudinal movement of center rod 436causes jaws 430, 432 to be cammed between open and closed positions.

Tool assembly 420 includes a drive assembly 440 slidably and rotatablydisposed within lumen 424 of support member 422. Drive assembly 440includes an inner drive assembly 442 and an outer drive assembly 444. Asseen in FIGS. 40-43, inner drive assembly 442 includes an inner barrelor collar 442 a defining a lumen 442 b there through and an annulargroove 442 c therearound. Lumen 442 b is configured to slidably androtatably receive center rod 436 therein. Inner drive assembly 442further includes a ring 450 a slidably supported in annular groove 442c, and a first blade 450 b extending from ring 442 d. Blade 450 bextends from ring 450 a in a direction substantially parallel to acentral longitudinal axis of lumen 442 b of inner barrel 442 a.

As seen in FIGS. 40 and 44-46, outer drive assembly 444 includes anouter barrel or collar 444 a defining a lumen 444 b there through and anannular groove 444 c formed in a surface of lumen 444 b. Lumen 444 b isconfigured to slidably and rotatably receive inner barrel 442 a therein,such that inner barrel 442 a is nested within lumen 444 b of outerbarrel 444 a. Outer drive assembly 444 further includes a ring 452 aslidably supported in annular groove 444 c, and a second blade 452 bextending from ring 444 d. Blade 452 b extends from ring 452 a in adirection substantially parallel to a central longitudinal axis of lumen444 b of outer barrel 444 a.

Tool assembly 420 further includes a clevis 446 disposed between arms426 of support member 422. Clevis 446 includes a pair of spaced apartarms 446 b extending from a base 446 a. Each arm 446 b defines a lumen446 c therethrough. Clevis 446 defines a central aperture 446 d formedin base 446 a. Arms 446 b are spaced apart an amount sufficient andcentral aperture 446 d of base 446 b is dimensioned so as to slidablyand rotatably receive center rod 436 therein.

Tool assembly 420, as discussed above, further includes a pair of needleengaging members or blades 450 b, 452 b which are slidably supportedwithin a respective lumen 446 c of arms 446 b of clevis 446. Each blade450 b, 452 b includes a distal end slidably extending into bladereceiving channels 430 d, 432 d (see FIGS. 47-49) of respective jaws430, 432.

In operation, as inner drive assembly 442 and outer drive assembly 444are translated, in an axial direction, relative to one another, blades450 b, 452 b are also translated with respect to one another.

End effector 400 includes a joint assembly 460 interconnecting neckassembly 410 and tool assembly 420. Joint assembly 460 may be in theform of a knuckle joint, wherein a first member 462 a of joint assembly460 is supported in or at a distal end of a shaft or tubular housing 412of neck assembly 410, and a second member 462 b of joint assembly 460 issupported at or in a proximal end of support member 422 of tool assembly420. Joint assembly 460 enables tool assembly 420 to articulate orpivot, about at least one axis, relative to neck assembly 410.

End effector 400 further includes a pair of pusher-rods 464 a, 464 beach extending through respective lumens formed in first member 462 aand second member 464 b of joint assembly 460, and secured to innerbarrel 442 a of inner drive assembly 442 and outer barrel 444 a of outerdrive assembly 444, respectively. In use, as pusher-rods 464 a, 464 bare translated relative to one another respective inner barrel 442 a andouter barrel 444 a are translated relative to one another.

Turning now to FIGS. 47-51, a method of operating end effector 400 isshown and described. As seen in FIG. 47, when pusher-rod 464 a is at adistal-most position, inner barrel 442 a and blade 450 b are at adistal-most position, meanwhile pusher-rod 464 b may be desirablymaintained at a proximal-most position so as to maintain outer barrel444 a and blade 452 b at a proximal-most position. It is contemplatedthat pusher-rods 464 a, 464 b may be maintained at any axial locationrelative to one another so as to maintain respective inner barrel 442 aand blade 450 b, and outer barrel 444 a and blade 452 b at any axiallocation relative to one another.

As seen in FIGS. 47 and 48, when center rod 436 is at a distal-mostposition, jaws 430, 432 are in an open condition, and when center rod436 is retracted, relative to end effector 400, jaws 430, 432 are in aclosed condition. Similar to end effector 200, in order to open or closejaws 430, 432, of end effector 400, central rod 436 is translated in anaxial direction to move camming pin 438. Camming pin 438 rides throughthe camming slots of jaws 430, 432 thus causing jaws 430, 432 to pivotabout pivot pin 434 and cause distal ends of jaws 430, 432 to open orclose.

A seen in FIGS. 47-49, when pusher-rod 464 a is moved in a proximaldirection to a proximal-most position, inner barrel 442 a and blade 450b are moved in a proximal direction, and when pusher-rod 464 b is movedin a distal direction to a distal-most position, outer barrel 444 a andblade 452 b are moved in a distal direction.

As seen in FIGS. 50 and 51, upon rotation of center rod 436 about alongitudinal axis thereof, camming pin 438 acts on arms 426 of supportmember 422 to cause support member 422 and tool assembly 420 to rotaterelative to neck assembly 410. As tool assembly 420 is rotated, rings450 a, 452 a of respective inner and outer drive assemblies 442, 444,are rotated relative to respective inner and outer barrels 442 a, 444 a,thereby allowing respective blades 450 b, 452 b to rotate with toolassembly 420.

Turning now to FIGS. 52-55, an end effector, according to anotherembodiment of the present disclosure, is generally designated as endeffector 500. End effector 500 is substantially similar to end effector400 and thus will only be described herein to the extent necessary toidentify differences in construction and operation thereof. Throughoutthe following disclosure, like reference numeral will be used toidentify like elements.

As seen in FIGS. 52-55, pusher-rods 464 a, 464 b have been replaced byarms 564 a, 564 b extending proximally from respective inner and outerbarrels 542 a, 544 a. Tool assembly 520 of end effector 500 includes acamming hub 566 defining a lumen 566 a therethrough configured andadapted to slidably receive a portion of center rod 536 therein. Camminghub 566 defines a substantially helical or spiral groove 566 b in anouter surface thereof configured for slidable receipt of a nubprojecting from arms 564 a, 564 b. Camming hub 566 is configured forrotatable disposition within lumen 524 of support member 522.

With continued reference to FIGS. 52-55, a method of operating endeffector 500 is shown and described. As seen in FIG. 52, when innerbarrel 542 a and blade 550 b are at a distal-most position, outer barrel544 a and blade 552 b are at a proximal-most position.

As seen in FIGS. 52 and 53, when center rod 536 is at a distal-mostposition, jaws 530, 532 are in an open condition, and when center rod536 is retracted, relative to end effector 520, jaws 530, 532 are in aclosed condition. Similar to end effector 200, in order to open or closejaws 530, 532, of end effector 500, central rod 536 is translated in anaxial direction to move camming pin 538. Camming pin 538 rides throughthe camming slots of jaws 530, 532 thus causing jaws 530, 532 to pivotabout pivot pin 534 and cause distal ends of jaws 530, 532 to open orclose.

A seen in FIGS. 52-55, when camming hub 566 is rotated by a drive tube567, nubs of arms 564 a, 564 b ride within groove 566 b of camming hub566 and are translated, in an axial direction, relative thereto. Inparticular, upon rotation of camming hub 566, as arm 564 a is movedproximally, inner barrel 542 a is moved proximally, and concomitantlytherewith arm 564 b is moved distally thereby moving outer barrel 544 adistally, and vise-versa. As inner barrel 542 a is moved in a proximaldirection, blade 550 b is also moved in a proximal direction, andconcomitantly therewith since outer barrel 544 a is moved in a distaldirection, blade 552 b is moved in a distal direction.

Turning now to FIGS. 56-59, an end effector, according to anotherembodiment of the present disclosure, is generally designated as endeffector 600. End effector 600 is substantially similar to end effector400 and thus will only be described herein to the extent necessary toidentify differences in construction and operation thereof. Throughoutthe following disclosure, like reference numeral will be used toidentify like elements.

As seen in FIGS. 56-59, pusher-rods 664 a, 664 b extend from respectivedistal and proximal barrels 642 a, 644 a. Distal and proximal barrels642 a, 644 a are not configured for nesting within one another, in themanner of inner and outer barrels 442 a, 444 a.

With continued reference to FIGS. 56-59, a method of operating endeffector 600 is shown and described. As seen in FIG. 56, when pusher-rod664 a is at a distal-most position, distal barrel 642 a and blade 650 bare at a distal-most position, meanwhile pusher-rod 664 b may bedesirably maintained at a proximal-most position so as to maintainproximal barrel 644 a and blade 652 b at a proximal-most position. It iscontemplated that pusher-rods 664 a, 664 b may be maintained at anyaxial location relative to one another so as to maintain respectivedistal barrel 642 a and blade 650 b, and proximal barrel 644 a and blade652 b at any axial location relative to one another.

As seen in FIGS. 56 and 57, when center rod 636 is at a distal-mostposition, jaws 630, 632 are in an open condition, and when center rod636 is retracted, relative to end effector 600, jaws 630, 632 are in aclosed condition. Similar to end effector 200, in order to open or closejaws 630, 632, of end effector 600, central rod 636 is translated in anaxial direction to move camming pin 638. Camming pin 638 rides throughthe camming slots of jaws 630, 632 thus causing jaws 630, 632 to pivotabout pivot pin 634 and cause distal ends of jaws 630, 632 to open orclose.

A seen in FIGS. 56-59, when pusher-rod 664 a is moved in a proximaldirection to a proximal-most position, distal barrel 642 a and blade 650b are moved in a proximal direction, and when pusher-rod 664 b is movedin a distal direction to a distal-most position, proximal barrel 644 aand blade 652 b are moved in a distal direction. As seen in FIG. 59,either pusher-rod 664 a, 664 may be moved until distal barrel 642 a andproximal barrel 644 a are in contact with one another.

Turning now to FIG. 60, an end effector, according to another embodimentof the present disclosure, is generally shown as 700.

End effector 700 includes a neck assembly (not shown), and a toolassembly 720 supported on a distal end of the neck assembly. As seen inFIG. 60, tool assembly 720 of end effector 700 includes a jaw supportmember 722, and a pair of jaws 730, 732 mounted for pivotable movementon jaw support member 722.

Each jaw 730, 732 includes a needle receiving recess 730 a, 732 a,respectively, configured to surround and hold at least a portion of asurgical needle 104 disposed therein substantially perpendicular totissue engaging surfaces thereof.

Jaws 730, 732 are pivotably mounted on support member 722 by means of ajaw pivot pin 734. To move jaws 730, 732 between an open position and aclosed position there is provided an axially or longitudinally movablecenter rod 736 having a camming pin 738 mounted at a distal end thereof.Camming pin 738 rides in and engages angled camming slots 730 c, 732 cformed in respective jaws 730, 732 such that axial or longitudinalmovement of center rod 736 causes jaws 730, 732 to be cammed betweenopen and closed positions.

Tool assembly 720 includes a lead screw 740 having a distal endthreadably connected to a proximal end of center rod 736. Lead screw 740includes a proximal end fixedly connected to a distal end of anactuation cable 742 via a coupling 746. Actuation cable 742 rotatablyand slidably extends through a bearing 748.

Tool assembly 720 further includes a bell crank 744 pivotally supportedon support member 722. Bell crank 244 includes a pair of opposed arms orlevers 744 a, 744 b.

In operation, rotation of actuation cable 742 imparts rotation tocoupling 746 and lead screw 740 which, in turn, imparts axial reciprocaltranslation to center rod 736 and camming pin 738. Thus, rotation ofactuation cable 742 results in the approximation (closing) or separation(opening) of jaws 730, 732 relative to one another.

Tool assembly 720 further includes a pair of needle engaging members orblades 750, 752 which are slidably supported within respective bladereceiving channels of jaws 730, 732. The channels of jaws 730, 732 aredimensioned and configured so as to at least partially intersect needlerecesses 730 a, 732 a. Thus, by advancing blade 750 or 752 within arespective channel, a distal end 750 a, 752 a of the advancing blade 750or 752 engages or “locks in” a groove of needle disposed within therespective recess 730 a, 732 a. Each blade 750, 752 includes a proximalend 750 b, 752 b pivotably connected to a free end of a respective lever744 a, 744 b of bell crank 744.

In operation, as actuation cable 742 axially reciprocated, levers 744 a,744 b are actuated in opposite directions to move respective blades 750,752 in a respective axial direction relative thereto. In particular,upon axial movement of actuation cable 742 in a first direction, lever744 a, and in turn blade 750, is caused to be moved in a first directionwhile lever 744 b, and in turn blade 752, is caused to be moved in asecond direction, and vise-versa.

Turning now to FIG. 61, a drive assembly or actuation cable assembly842, for use with the end effectors of the present disclosure, is shownand will be described. Drive assembly 842 includes an inner cable 842 aand an outer tube or sheath 842 b rotatably and slidably extending overinner cable 842 a. Inner cable 842 a is fabricated from a suitablematerial capable or transmitting axial tensile and compressive forces,and torsional or rotational forces. Outer tube 842 b is fabricated froma suitable material also capable or transmitting axial tensile andcompressive forces, and torsional or rotational forces.

Turning now to FIG. 62, an end effector, according to another embodimentof the present disclosure, is generally shown as 900. End effector 900includes a tool assembly 920 having a pair of jaws 930, 932 pivotablyassociated with one another. Jaws 930, 932 are pivotably associated withone another by means of a jaw pivot pin 933. Each jaw 930, 932 includesa respective proximal end or tail 934, 936 converging toward oneanother. Each tail 934, 936 includes a respective outer surface 934 a,936 a, and a respective inner surface 934 b, 936 b.

Tool assembly 920 includes a lead screw 940, fixedly connected toactuating cable 942, and having a distal end threadably connected to aproximal end of a wedge member 936. Wedge member 936 includes a distallyextending head portion 936 a interposed between tails 934, 936 of jaws930, 932, and arms 936 b, 936 c disposed outside of respective tails934, 936. Head portion 936 a may by triangular, conical or any othersuitably shaped configuration selected for the intended purpose ofseparating tails 934, 936 from one another as wedge member 936 is movedin a first direction away from pivot pin 933. Arms 936 b, 936 c mayextend distally or toward pivot pin 933, may comprise a portion of aflange or skirt extending toward pivot pin 933, or may comprise anyother suitably shaped configuration selected for the intended purpose ofapproximating tails 934, 936 toward one another as wedge member 936 ismoved in a second direction toward pivot pin 933.

In operation, to close jaws 930, 932 from an open condition, actuationcable 942 is rotated in a first direction to rotate lead screw 940 in afirst direction and move wedge member 936 is a first direction axiallyrearward. In so doing, head portion 936 a of wedge member 936 is movedin an axially rearward direction, away from pivot pin 933, to engage andseparate tails 934, 936 of jaws 930, 932 from one another to therebyclose jaws 930, 932.

Similarly, to open jaws 930, 932 from a closed condition, actuationcable 942 is rotated in a second direction to rotate lead screw 940 in asecond direction and move wedge member 936 is a second direction axiallyforward. In so doing, arms 936 b, 936 c of wedge member 936 are moved inan axially forward direction, toward pivot pin 933, to engage andapproximate tails 934, 936 of jaws 930, 932 towards one another tothereby open jaws 930, 932.

Turning now to FIG. 63, a closure member in accordance with anembodiment of the present disclosure, for any of the end effectorsdisclosed herein, is generally shown as 1022. Closure member 1022includes an outer tube 1024 having a proximal portion 1024 a which isflexible or resilient and a distal portion 1024 b which is rigid or hasa fixed configuration. It is contemplated that proximal portion 1024 aof outer tube 1024 is fabricated from a suitable material which is notaxially compressible or extensible. Closure member 1022 includes aninner flexible tube 1026 rotatably and slidably disposed within outertube 1024. Inner flexible tube 1026 includes a distal end configured tooperatively engage and support joints 112 of neck assembly 110.

It is contemplated that jaws 130, 132 may be biased to an open conditionby a suitable biasing member (not shown).

In operation, outer tube 1024 of closure member 1022 is reciprocallytranslated relative to inner tube 1026 and jaws 130, 132 to open andclose jaws 130, 132 as needed and/or desired. With jaws 130, 132 in anopen condition and distal portion 1024 b of outer tube 1024 locatedproximal of jaws 130, 132, in order to close jaws 130, 132, outer tube1024 is axially advanced relative to inner tube 1026 and jaws 130, 132such that distal portion 1024 b of outer tube 1024 engages a rear orback surface of jaws 130, 132 and cams or urges jaws 130, 132 relativeto one another and biases the biasing member. With jaws 130, 132 in aclosed condition, at least partially within outer tube 1024, in order toopen jaws 130, 132, outer tube 1024 is axially retracted relative toinner tube 1026 and jaws 130, 132 such that distal portion 1024 b ofouter tube 1024 disengages a rear or back surface of jaws 130, 132 andjaws 130, 132 are separated relative to one another by the un-biasing ofthe biasing member.

Turning now to FIG. 64, a drive assembly 1142, for use with the endeffectors of the present disclosure, is shown and will be described. Asseen in FIG. 64, drive assembly 1142 includes a center rod or actuationrod 1136 slidably supported on at least one bushing 1137 and includes aproximal end 1136 a. Drive assembly 1142 includes an eccentric cam 1144rotatably supported on a pin 1145. A surface of cam 1144 is in slidablecontact with proximal end 1136 a of actuation rod 1136. It iscontemplated that actuation rod 636 is biased into engagement or contactwith the surface of cam 1144.

Drive assembly 1142 further includes a toothed wheel or gear 1146supported on pin 1145 and keyed to cam 1144. Drive assembly 1142 mayinclude a latch 647 operatively engaged with the teeth of gear 1146 toallow for gear 1146 to only rotate in a single direction.

Drive assembly 1142 further includes a bell crank 1148 pivotablysupported on a pin 1149. Bell crank 1148 include a pair of arms 1148 a,1148 b extending away from pin 1149. Drive assembly 1142 includes a pawl1150 pivotably connected to arm 1148 a of bell crank 1148 and biasedagainst the teeth of gear 1146. Pawl 1150 is configured to impartrotation to gear 1146 in a single direction.

Drive assembly 1142 further includes a pair of reigns or actuationcables 1114 a, 1114 b. Actuation cables 1114 a, 1114 b may be connectedto a respective arm 648 a, 1148 b of bell crank 1148.

In operation, as first actuation cable 1114 a is pulled, arm 1148 a ofball crank 1148 is moved to pull on pawl 1150 in a first direction. Aspawl 1150 is moved in a first direction, gear 1146 is rotated in a firstdirection thus causing cam 1144 to rotate in a first direction. As cam1144 is rotated, actuation rod 1136 rides along an outer surface thereofto move is an axially distal or proximal direction. Once the stroke orpull of first actuation cable 1114 a is complete, second actuation cable1114 b is pulled to reset pawl 1150.

As second actuation cable 1114 b is pulled, arm 1148 b of ball crank1148 is moved to move arm 1114 a in a second direction to push pawl 1150in a second direction. As pawl 1150 is moved in a second direction, pawl1150 rides over the teeth of gear 1146 and latch 1124 prevents gear 1146from rotating in a second direction and thus cam 1144 is prevented fromrotating in a second direction.

The pulling of actuation cables 1114 a, 1114 b is continuously repeatedto move actuation rod 1136 in a distal and a proximal direction to openand close jaws of an end effector, as described in embodiments disclosedherein.

If desired, a second gear 1146 a and a second pawl 1150 a may beprovided to cause rotation of cam 1144 in a second direction as secondactuation cable 1114 b is pulled.

In an embodiment, it is contemplated that a first bevel gear may bekeyed to gear 1146 such that rotation of gear 1146 may rotate the firstbevel gear, and a second bevel gear may be operatively connected to thefirst bevel gear such that rotation of the first bevel gear may be usedto impart an axial rotation to a drive rod via the second bevel gear.

Turning now to FIG. 65, an end effector according to another embodimentof the present disclosure, is generally shown as 1200. End effector 1200includes a pair of jaws 1230, 1232 pivotably joined to one another by apivot pin 1234. Each jaw 1230, 1232 includes a tail portion 1230 a, 1232a extending proximally of pivot pin 1233.

End effector 1200 further includes a pair of links 1234, 1236 pivotablyconnected to an end of a respective tail portion 1230 a, 1232 a of jaws1230, 1232. A free end of each link 1234, 1236 is pivotably joined toone another and is operatively connected to an actuation cable 1242.

In this embodiment, as actuation cable 1242 is moved in a proximaldirection relative to pivot pin 1233, jaws 1230, 1232 are caused to beapproximated towards one another. Additionally, as actuation cable 1242is moved in a distal direction relative to pivot pin 1233, jaws 1230,1232 are caused to be separated from one another. Similar to apantograph mechanism, links 1234, 1236 enable jaws 1230, 1232 to beopened to approximately 180° relative to one another in order to graspflat gastric walls or the like.

Turning now to FIG. 66, a drive assembly 1342 for any of the endeffectors disclosed herein is shown and will be described. As seen inFIG. 66, drive assembly 1342 includes a pulley 1344 pivotably supportingblades 1350, 1352 at substantially diametrically opposed sides thereof.Drive assembly 1342 further includes a cable or belt 1345 extendingaround pulley 1344.

In use, as an end of cable 1345 is pulled in a first direction, blade1350 is advanced, to selectively engage needle 104, and blade 1352 isretracted. Additionally, as an end of cable 1345 is pulled in a seconddirection, blade 1352 is advanced, to selectively engage needle 104, andblade 1350 is retracted.

Turning now to FIGS. 67A and 67B, a drive assembly 1442 for any of theend effectors disclosed herein is shown and will be described. As seenin FIGS. 67A and 67B, drive assembly 1442 includes a camming hub 1444supported on a drive cable 1414. Camming hub 1444 defines a spiralgroove 1444 b configured to slidably and selectively receive a follower1450 c, 1452 c of a respective blade 1450, 1452.

Drive assembly 1442 further includes an actuation tube 1416 extendingover actuation cable 1414 and including a cam 1418 supported on a distalend thereof. As actuation tube 1416 is rotated, a lobe 1418 a of cam1418 selectively engages and disengages a recess 1450 b, 1452 b formedin a proximal end of blades 1450, 1452.

In operation, actuation tube 1416 is rotated 90° to engage recess 1450 bof blade 1450 with lobe 1418 a of cam 1418. Lobe 1418 a lifts blade1450, pulling follower 1450 c out of groove 1444 b of camming hub 1444.Actuation tube 1416 is then moved forward, moving cam 1418 and blade1450 forward to engage or release the surgical needle. The process isrepeated as needed throughout the surgical procedure.

In an alternate embodiment, as seen in FIGS. 68A and 68B, camming hub1444 may be provided with a longitudinally extending slot or groove 1444b extending forward from a nadir of helical groove 1444 a. A retentionbump 1444 c may be provided at or near a proximal end of longitudinalgroove 1444 b.

As seen in FIG. 68A, blade 1450 may include a threaded portion 1450 dextending from a proximal end thereof through a threaded block orbushing 1451. An actuation or torque cable 1453 may be connected tothreaded portion 1450 d to push follower 1450 c over bump 1444 c asactuation cable 1453 is rotated to release the surgical needle.

Turning now to FIGS. 69-101, a flexible endoscopic stitching device, inaccordance with an embodiment of the present disclosure, is generallydesignated as 2000. Endoscopic stitching device 2000 includes an endeffector 2100 operatively supported on and extending from a handleassembly 2200.

In accordance with the present embodiment, end effector 2100 issubstantially similar to end effector 100 and thus will only bediscussed in detail hereinbelow to the extent necessary to identifydifferences in construction and operation. Reference may be made to endeffector 100 for a detailed discussion of the construction and operationof end effector 2100.

As seen in FIGS. 72, 82-84, 90, 93, 94, 97 and 98, end effector 2100includes a thrust bearing 2148 interposed between camming hub 2144 anddistal-most knuckle 2112 a. Thrust bearing 2148 includes a plurality ofball bearings 2148 a rotatably supported in housing halves 2148 b, 2148c.

In use, first housing half 2148 b of thrust bearing 2148 is freelyrotatable relative to second housing half 2148 c of thrust bearing 2148,via ball bearings 2148 a. In particular, thrust bearing 2148 enabledfree or relatively free axial rotation of camming hub 2144 relative todistal-most knuckle 2112 a.

Handle assembly 2200 includes a housing 2202 having a right-half section2202 a and a left-half section 2202 b joinable to one another bysuitable fastening elements (not shown), such as screws. Handle assembly2200 includes a trigger 2204 operatively supported in housing 2202 andextending therefrom. As will be described in greater detail below,trigger 2204 is movable between a first un-actuated position, as seen inFIGS. 69-71 and 68, and at least one second actuated position, as seenin FIGS. 79-81. In use, movement of trigger 2204 between the first andsecond positions results in actuation and/or operation of end effector2100.

Trigger 2204 is operatively associated or otherwise connected to anactuation mechanism 2210 (see FIGS. 70-72 and 78-82) of handle assembly2200. As will be described in greater detail below, in use, movement oftrigger 2204 between the first and second positions results in twooperations of end effector 2100.

As seen in FIGS. 70-72 and 78-82, actuation mechanism 2210 includes atrigger plate 2212 connected to and extending from trigger 2204. Triggerplate 2212 pivotally connects trigger 2204 to housing 2202. Triggerplate 2212 defines a first gear segment 2214 along a proximal or rearedge 2212 a thereof. Trigger plate 2212 defines an arcuate slot 2216therein having a second gear segment 2216 a formed along an upper edgethereof. Slot 2216 has a radius of curvature having its center locatedon a pivot axis “Y” (see FIG. 73) of trigger 2204.

A gear set 2220 is operatively associated with slot 2216 of triggerplate. Gear set 2220 includes a first gear 2222 configured to mesh withand/or otherwise operatively engage second gear segment 2216 a of slot2216, and a second gear 2224 supported on a common rotational pin 2226as first gear 2222. In this manner, as first gear 2222 is rotated due toa movement of trigger 2204, second gear 2224 is simultaneously and/orconcomitantly rotated.

Second gear 2224 of gear set 2220 is configured to mesh with and/orotherwise operatively engage teeth 2228 a of a rack 2228. Rack 2228defines a lumen 2228 b therethrough. Lumen 2228 b of rack 2228 isoriented in a direction tangential to pivot axis “Y”. In one embodiment,lumen 2228 b of rack 2228 is coaxially disposed on a longitudinal “X”axis of an actuation shaft of handle assembly 2200.

As seen in FIGS. 70-72 and 78-82, actuation mechanism 2210 includes adrive or actuation shaft 2230 extending through and operativelyassociated with rack 2228, and a follower block 2232 rotatably supportedon actuation shaft 2230 at a fixed location distal of rack 2228.Actuation shaft 2230 is axially translatable and rotatable relative torack 2228. Follower block 2232 is axially held in position relative toactuation shaft 2230 by a pair of ring clamps 2232 a, 2232 b secured toactuation shaft 2230 at a location distal and proximal of follower block2232. Rack 2228 and follower block 2232 are connected to one another bya biasing member 2234, i.e., a tension spring, extending therebetween.

Actuation mechanism 2210 includes a slip-clutch 2240 supported on aproximal end of actuation shaft 2230. As seen in FIG. 74, slip clutch2240 includes a distal portion 2242 having a distal bevel gear 2242 aconfigured to mesh with and/or otherwise operatively engage first gearsegment 2214 of trigger plate 2212, and a set of proximally-facing gearteeth 2242 b. Slip clutch 2240 further includes a proximal portion 2244having a set of distally-facing gear teeth 2244 a configured to meshwith and/or otherwise operatively engage the set of proximally-facinggear teeth 2242 b of distal portion 2242, and a toothed wheel 2244 blocated proximal of the set of distally-facing gear teeth 2244 a.Toothed wheel 2244 b defines a pair of diametrically opposed teeth 2244c formed therein or thereon. As seen in FIGS. 77, 80 and 83, toothedwheel 2244 b is keyed to actuation shaft 2230 so as to solely enableaxial displacement of toothed wheel 2244 b relative to actuation shaft2244 b.

In operation, as will be discussed in greater detail below, the set ofdistally-facing gear teeth 2244 a cooperate with the set ofproximally-facing gear teeth 2242 b to impart rotation in a singledirection.

Proximal portion 2244 of slip-clutch 2240 is biased against distalportion 2242 of slip-clutch 2240 by a biasing member 2246, such as, forexample, a compression spring or the like, disposed between housing 2202and proximal portion 2244 of slip-clutch 2240. A pawl 2248 isoperatively associated with toothed wheel 2244 b in such a manner so asto permit rotation of toothed wheel 2244 b in a single direction.

As seen in FIGS. 70-72, at least proximally-facing gear teeth 2242 b ofdistal portion 2242 of slip-clutch 2240 is retained in a hub 2250 formedin housing 2202, and at least a boss 2244 d, extending proximally fromtoothed wheel 2244 b, is retained in a hub 2252 formed in housing 2202.

With continued reference to FIGS. 69-82, a method of using and/oroperating handle assembly 2200 is shown and described. As seen in FIG.78, when trigger 2204 is in a first or un-actuated position, rack 2228is at a distal-most position relative to actuation shaft 2230 such thata proximal-most tooth 2228 a thereof meshes with and/or otherwiseoperatively engages second gear 2224 of gear set 2220. Also, as seen inFIG. 78, when trigger 2204 is in a first or un-actuated position, firstgear segment 2214 of trigger plate 2212 is spaced a distance from bevelgear 2242 a of distal portion 2242 of slip clutch 2240.

As seen in FIGS. 78 and 79, as trigger 2204 is squeezed or moved to asecond or at least partially actuated position, as indicated by arrow“A”, second gear segment 2216 a of slot 2216 causes first gear 2222 aswell as second gear 2224 of gear set 2220 to rotate in the direction ofarrow “B”. As first and second gears 2222, 2224 of gear set 2220 arerotated in the “B” direction, second gear 2224 causes rack 2228 to movein the direction of arrow “C” (i.e., in a proximal direction). As rack2228 is moved proximally, actuation shaft 2230 is also moved proximally,in the direction of arrow “C”, due to the connection of follower block2232 to rack 2230 via biasing member 2234. Proximal movement ofactuation shaft 2230 may result in an operation or movement in endeffector 2100 connected to a distal end of actuation shaft 2230 via anactuation cable 2231.

As seen in FIG. 79, as trigger 2204 is further squeezed or moved in thedirection of arrow “A”, first gear segment 2214 of trigger plate 2212operatively engages bevel gear 2242 a of distal portion 2242 of slipclutch 2240. As trigger 2204 is moved in the direction of arrow “A”,first gear segment 2214 of trigger plate 2212 imparts rotation to bevelgear 2242 a of distal portion 2242 of slip clutch 2240, in the directionof arrow “D”. Rotation of bevel gear 2242 a of distal portion 2242 ofslip clutch 2240 in turn imparts rotation to proximal portion 2244 ofslip clutch 2240, due to the meshing of respective gear teeth 2242 b,2244 a, which in turn imparts rotation to actuation shaft 2230, due tothe keying of toothed wheel 2244 b of proximal portion 2244 to actuationshaft 2230.

As seen in FIGS. 77 and 80, as toothed wheel 2244 b of proximal portion2244 of slip clutch 2240 is rotated in the direction of arrow “D”, pawl2248 rides over and against an outer surface thereof.

As seen in FIG. 81, as trigger 2204 is further squeezed or moved in thedirection of arrow “A”, second gear 2224 of gear set 2220 is furtherrotated in the direction of arrow “B” causing rack 2228 to move furtherin the direction of arrow “C”. However, since actuation shaft 2230 hasbottomed out (i.e., movement in the direction of arrow “C” is stopped),rack 2228 is caused to move in the direction of arrow “C” alongactuation shaft 2230, and since follower block 2232 is axially fixedalong actuation shaft 2230, biasing member 2234 is caused to beelongated. Simultaneously or concomitantly therewith, first gear segment2214 of trigger plate 2212 further rotates bevel gear 2242 a of distalportion 2242 of slip clutch 2240 in the direction of arrow “D” furtherrotating actuation shaft 2230 in the direction of arrow “D”, asdescribed above. Rotation of actuation shaft 2230 in the direction ofarrow “D” may result in another operation or movement in end effector2100 connected to a distal end of actuation shaft 2230 via an actuationcable 2231.

Turning now to FIG. 82, as trigger 2204 is released or moved in thedirection of arrow “A1”, opposite to the direction of arrow “A”, secondgear 2224 of gear set 2220 is rotated in the direction of arrow “B1”,opposite to arrow “B”. Second gear 2224 is moved in the direction ofarrow “B1” either by the movement of trigger 2204 in the direction ofarrow “A1” or by the movement of rack 2228 in the direction of arrow“C1”, opposite to the direction of arrow “C”. Rack 2228 is moved in thedirection of arrow “C1” due to the contraction of biasing member 2234approximating rack 2228 toward follower block 2232. The spring bias ofbiasing member 2234, approximating rack 2228 toward follower block 2232,facilitates or aids in the return or movement of trigger 2204 in thedirection of arrow “A1”. As rack 2228 is moved in the direction of arrow“C1” actuation shaft 2230 is also moved in the direction of arrow “C1”.

Simultaneously or concomitantly with the movement of trigger 2204 in thedirection of arrow “A1”, first gear segment 2214 of trigger plate 2212imparts rotation to bevel gear 2242 a of distal portion 2242 of slipclutch 2240 in the direction of arrow “D1”, opposite to the direction ofarrow “D”. As bevel gear 2242 a of distal portion 2242 of slip clutch2240 is rotated in the direction of arrow “D1” gear teeth 2242 b thereofslips-over and/or against teeth 2244 a of proximal portion 2244 of slipclutch 2240, and since proximal portion 2244 of slip clutch 2240 iscammed in the direction of arrow “D”, against the bias of spring 2246,no rotation is imparted to proximal portion 2244 of slip clutch 2240. Inturn, since proximal portion 2244 of slip clutch 2240 does not rotate,no rotation is imparted to actuation shaft 2230.

As seen in FIG. 83, as toothed wheel 2244 b of proximal portion 2244 ofslip clutch 2240 is rotated in the direction of arrow “D1”, pawl 2248abuts against a tooth 2244 c of toothed wheel 2244 b, preventingrotation of toothed wheel 2244 b in the direction of arrow “D1” and inturn preventing rotation of actuation shaft 2230 in the direction ofarrow “D1”.

Movement of actuation shaft 2230 in the direction of arrow “C1” mayresult in yet another operation or movement in end effector 2100connected to a distal end of actuation shaft 2230 via an actuation cable2231.

Turning now to FIGS. 69-73 and 75-76, handle assembly 2200 furtherincludes an articulation mechanism 2270 supported on and/or in housing2202. Articulation assembly 2270 may be operatively connected to endeffect 2100 in order to impart articulation to end effector 2100 or anyother suitable movement or operation to end effector 2100.

As seen in FIGS. 69-73 and 75-76, articulation mechanism 2270 includes aknob or dial 2272 rotatably supported on or in housing 2202, and a gearset 2274 keyed to and shaving a common rotational axis as dial 2272.Gear set 2274 includes a first gear 2274 a and a second gear 2274 b eachsupported on and keyed to a pin 2276 extending therethrough and throughdial 2272.

As seen in FIGS. 72 and 73, first gear 2274 a of gear set 2274operatively engages a locking/feedback member 2278 including a finger2278 a biased against the teeth of first gear 2274 a. In operation, asfirst gear 2274 a of gear set 2274 is rotated, due to a rotation of dial2272, finger 2278 a rides over the teach of first gear 2274 a therebyproviding the user with tactile and/or audible feedback. Additionally,when dial 2272 is not rotated, finger 2278 a inter-engages with theteeth of first gear 2274 a to thereby inhibit automatic rotation of dial2272 and thus essentially lock or fix the position of dial 2272.

Articulation mechanism 2270 further includes a pair of opposed racks2280 a, 2280 b operatively engaged with and on opposed sides of secondgear 2274 b of gear set 2274. Each rack 2280 a, 2280 b is slidablysupported within a respective channel 2282 a, 2282 b of a support member2282. Each rack 2280 a, 2280 b includes a respective articulation cable2284 a, 2284 b secured thereto. In this manner, during operation, aseach rack 2280 a, 2280 b is displaced so to is each respectivearticulation cable 2284 a, 2284 b.

In operation, as best seen in FIGS. 75 and 76, as second gear 2274 b isrotated in a direction of arrow “E”, due to the rotation of dial 2272,first rack 2280 a is moved in a proximal direction (i.e., in thedirection of arrow “F”), thus displacing first articulation cable 2284 ain the direction of arrow “F”, and second rack 2280 b is moved in adistal direction (i.e., in the direction of arrow “F1”, opposite toarrow “F”), thus displacing second articulation cable 2284 b in thedirection of arrow “F1”. It is understood that rotation of dial 2272 inan opposite direction and thus rotation of second gear 2274 b in adirection opposite to arrow “E” will result in movement and/ordisplacement of racks 2280 a, 2280 b and cables 2284 a, 2284 b inopposite directions. Rotation of dial 2272 thus may impart an operationor movement in end effector 2100.

As seen in FIGS. 69, 71, 73-81, 91, 95, 99, and 100, handle assembly2200 further includes a needle loading assembly 2300 including a knob2310 supported on a rear end of housing 2202 and configured to enableloading of a surgical needle in jaws 2130, 2132. Knob 2310 is keyed to aspline shaft 2312 via a nut 2314. Nut 2314 has a shaped outer surfacefor receipt in a complementary shaped recess formed in knob 2310 suchthat rotation of knob 2310 results in rotation of nut 2314. Nut 2314defines a shaped lumen 2314 a (FIG. 81) for receipt of a complementaryshaped outer surface of spline shaft 2312 such that rotation of knob2310 also results in rotation of spline shaft 2312. Spline shaft 2312 isaxially slidably disposed within lumen 2314 a of nut 2314.

As seen in FIGS. 73, 81, 91, 95, 99 and 100, a distal end of splineshaft 2312 extends through slip-clutch 2240 and is fixedly secured to aproximal end of actuation shaft 2230 (a distal end of actuation shaft2230 being connected to actuation cable 2142).

In use, in order to load a surgical needle into jaws 2130, 2132 of endeffector 2100, knob 2310 is rotated, thereby rotating spline shaft 2312,actuation shaft 2230, actuation cable 2142 and camming hub 2144 (asdescribed above). As knob 2310 is rotated, blades 2150, 2152 are movedaxially until the distal ends of blades 2150, 2152 are out ofregistration with needle receiving recesses 2130 a, 2132 a (FIG. 93).With the distal ends of blades 2150, 2152 out of registration withreceiving recesses 2130 a, 2132 a of jaws 2130, 2132, a surgical needle104 is inserted into one of the receiving recesses 2130 a, 2132 a. Knob2310 is then rotated until the distal end of one of blades 2150, 2152engages surgical needle 104, as described above.

By way of example only, endoscopic stitching device 2000 may beconfigured such that knob 2310 is rotated until an audible or tactilefeedback is sensed (e.g., when pawl 2248 snaps over tooth 2244 c oftoothed wheel 2244 b). At this point, surgical needle 104 may beinserted or loaded in the recess 2130 a, 2132 a of jaws 2130, 2132 whichis unobstructed. With the surgical needle 104 in position, knob 2310 maybe rotated to advance on of blades 2150, 2152 to engage surgical needle104, in the manner described above, and to lock surgical needle 104 inposition therein.

Referring now to FIGS. 102-110, a handle assembly for operating,manipulating and/or controlling an endoscopic device, in accordance withanother embodiment of the present disclosure, is generally designated as3100. Handle assembly 3100 includes a housing 3102 having a right-halfsection 3102 a and a left-half section 3102 b joinable to one another bysuitable fastening elements 3102 c, such as screws 3102 c, as shown inFIG. 105.

Handle assembly 3100 includes a trigger 3104 operatively supported inhousing 3102 and extending therefrom. As will be described in greaterdetail below, trigger 3104 is movable between a first un-actuatedposition, as seen in FIGS. 102-104, and a second actuated position, asseen in FIG. 109. In use, movement of trigger 3104 between the first andsecond positions results in actuation and/or operation of an endeffector (not shown).

Trigger 3104 is operatively associated or otherwise connected to anactuation mechanism 3110 (see FIG. 107) of handle assembly 3100. As willbe described in greater detail below, in use, movement of trigger 3104between the first and second positions results in two operations of anend effector.

As seen in FIGS. 103-105, 107, 109 and 110, actuation mechanism 3110includes a trigger plate 3112 connected to and extending from trigger3104. Trigger plate 3112 defines a gear segment 3114 along a proximal orrear edge 3112 a thereof.

Actuation mechanism 3110 includes a cam plate 3116 fixedly supported orconnected to trigger plate 3112. Cam plate 3116 is secured to triggerplate 3112 so as to rotate about a pivot axis “Y” (see FIG. 105) oftrigger 3104 and trigger plate 3112. Cam plate 3116 defines a cam slot3116 a formed therein including a first, second and third section 3116b, 3116 c, and 3116 d (see FIG. 105), respectively. Cam slot 3116 a hasa substantially “S-shaped” configuration. As seen in FIGS. 105 and 107,a cam follower 3118 is slidably positioned in cam slot 3116 a of camplate 3116.

Actuation mechanism 3110 includes a cam follower block 3120 operativelyassociated with cam plate 3116. Follower block 3120 pivotably supportscam follower 3118 via a pivot pin 3118 a or the like. In use, as will bedescribed in greater detail below, as trigger 3140 moved between thefirst and second positions, cam plate 3116 is pivoted about pivot axis“Y” and follower block 3120 is displaced along cam slot 3116 a of camplate 3116. As best seen in FIGS. 105 and 107, follower block 3120defines a lumen 3120 a therethrough. Lumen 3120 a of follower block 3120is oriented in a direction orthogonal to pivot axis “Y”. In oneembodiment, lumen 3120 a of follower block 3120 is coaxially disposed ona longitudinal “X” axis of a drive shaft of handle assembly 3100.

As seen in FIGS. 103-105, 107, 109 and 110, actuation mechanism 3110includes a drive or actuation shaft 3122 extending through andoperatively associated with follower block 3120. Actuation shaft 3122 isaxially fixed relative to follower block 3120 by a pair of retainingrings 3124 a, 3124 b connected to actuation shaft 3122 at a respectivelocation distal and proximal of follower block 3120. In this manner,actuation shaft 3122 is free to rotate about a longitudinal axisthereof, relative to follower block 3120, and moves distally andproximally with a corresponding distal or proximal movement of followerblock 3120.

Actuation mechanism 3110 includes a coil or compression spring 3126disposed on actuation shaft 3122 at a location proximal of followerblock 3120. Actuation mechanism 3110 further includes a pinion gear 3128rotatably supported on actuation shaft 3122 at a location proximal ofspring 3126. Pinion gear 3128 is positioned on actuation shaft 3122 soas to operatively engage and/or mesh with gear segment 3114 of triggerplate 3112.

Actuation mechanism 3110 further includes a toothed wheel 3130 fixedlysupported on or connected to actuation shaft 3122 via a screw orfastener 3130 a. Toothed wheel 3130 defines a pair of diametricallyopposed teeth 3130 b formed therein or thereon. Toothed wheel 3130 isdisposed at a location proximal of pinion gear 3128 and is in frictionalengagement therewith. A pawl 3132 is operatively associated with toothedwheel 3130 in such a manner so as to permit rotation of toothed wheel3130 in a single direction.

With continued reference to FIGS. 102-110, a method of using and/oroperating handle assembly 3100 is shown and described. As seen in FIGS.103 and 104, when trigger 3104 is in a first or un-actuated position,cam follower 3118 is positioned proximate a distal end of second section3116 c of cam slot 3116 a of cam plate 3116.

As seen in FIG. 109, when trigger 3104 is squeezed to a second or fullyactuated position, gear segment 3114 of trigger plate 3112 is pivotedabout pivot axis “Y” and actuates (i.e., rotates) pinion gear 3128 in afirst direction “A”. Since pinion gear 3128 is rotatably supported onactuation shaft 3122, no rotation of actuation shaft 3122 is impartedthereto. Also, since pinion gear 3128 frictionally engages toothed gear3130, rotation of pinion gear 3128 imparts rotation to toothed gear3130. However, as seen in FIGS. 106 and 109, rotation of toothed gear3130, in the direction of arrow “A”, is prevented by theinter-engagement of pawl 3132 with a tooth 3130 b of toothed gear 3130.

With continued reference to FIG. 109, simultaneously or concomitantlywith the rotation of pinion gear 3128 in the direction of arrow “A”, astrigger 3104 is squeezed to a second or fully actuated position, camfollower 3118 is caused to be displaced through cam slot 3116 a of camplate 3116. As cam follower 3118 is moved through cam slot 3116 a,follower block 3120 is caused to be moved in a proximal direction, asindicated by arrow “B”. Movement of follower block 3120 in the directionof arrow “B” results in the movement of actuation shaft 3122 in thedirection of arrow “B”. Movement of actuation shaft 3122 solely in anaxial direction is accomplished through uprights or guides 3140 a, 3140b, located near a distal end and a proximal end of actuation shaft 3122.

Movement of actuation shaft 3122 in the direction of arrow “B” resultsin movement of an adjustment screw 3142, operatively connected to adistal end of actuation shaft 3122, in the direction of arrow “B”, whichin turn results in movement of a first actuation cable 3144 in thedirection of arrow “B”. Movement of first actuation cable 3144, in thedirection of arrow “B”, may result in a first operation or movement ofan end effector (not shown), such as, for example, an approximation oran opening or jaws of the end effector. In an alternative embodiment(not shown), a rigid or substantially rigid rod or shaft may besubstituted for actuation cable 3144.

As seen in FIG. 110, upon release of trigger 3104 or upon the return oftrigger 3104 to the first or un-actuated condition, gear segment 3114 oftrigger plate 3112 is pivoted about pivot axis “Y” and actuates (i.e.,rotates) pinion gear 3128 in a second direction “C”, opposite to firstdirection “A”. Since pinion gear 3128 frictionally engages toothed gear3130, rotation of pinion gear 3128 in the direction of arrow “C” impartsrotation to toothed gear 3130. As seen in FIGS. 106 and 110, rotation oftoothed gear 130, in the direction of arrow “C”, is permitted since pawl3132 does not engage tooth 3130 b of toothed gear 3130 but simply slidesthereover.

Since toothed gear 3130 is keyed to or otherwise fixedly connected toactuation shaft 3122, rotation of toothed gear 3130 in the direction ofarrow “C” also results in rotation of actuation shaft 3122, and in turnfirst actuation cable 3144, in the direction of arrow “C”. Rotation offirst actuation cable 3144 in the direction of arrow “C” may result in asecond operation or movement of an end effector (not shown).

With continued reference to FIG. 110, simultaneously or concomitantlywith the rotation of pinion gear 3128 in the direction of arrow “C”, astrigger 3104 is moved or returned to the first or un-actuated position,cam follower 3118 is caused to be displaced through cam slot 3116 a ofcam plate 3116. As cam follower 3118 is moved through cam slot 3116 a,follower block 3120 is caused to be moved in a distal direction, asindicated by arrow “D”. Movement of follower block 3120 in the directionof arrow “D” results in the movement of actuation shaft 3122 in thedirection of arrow “D”. Guides 3140 a, 3140 b once again solely permitmovement of actuation shaft 3122 in an axial direction.

Movement of actuation shaft 3122 in the direction of arrow “D” resultsin movement of adjustment screw 3142, and in turn first actuation cable3144 in the direction of arrow “D”. Movement of first actuation cable3144, in the direction of arrow “D”, may result in a third operation ormovement of an end effector (not shown), such as, for example, anapproximation or an opening or jaws of the end effector.

Return or movement of trigger 3104 from the second position to the firstposition is facilitated by a tension spring 3148 or the like operativelyconnected to and extending between housing 3102 and trigger 3104.

With continued reference to FIGS. 102-110, handle assembly 3100 furtherincludes another actuation mechanism or articulation controller 3150.Articulation controller 3150 includes a slider 3152 slidably supportedin tracks 3102 d formed in housing 3102. Slider 3152 is biased to araised position by a biasing member 3154 (i.e., spring clip or thelike). In the raised position, a tooth 3152 a formed on slider 3152engages with a tooth 3156 a of a rack 3156 formed in housing 3102. Asecond actuation cable 3146 extends from slider 3152 and out through adistal end of housing 3102 to operative engage an end effector (notshown).

In operation, as seen in FIG. 109, as slider 3152 is actuated or movedin the direction of arrow “E” (i.e., from a proximal-most to adistal-most position), second actuation cable 3146 is also moved in thedirection of arrow “E”. Movement of second actuation cable in thedirection of arrow “E” may result in an operation of an end effector(not shown), such as, for example, an articulation of an end effector ina direction or an approximation or an opening or jaws of the endeffector.

In order to move slider 3152 in a direction opposite to arrow “E”,slider 3152 is pressed toward housing 3102 to disengage tooth 3152 athereof from teeth 3156 a of rack 3156. In this manner, slider 3152 isfree to be moved from a distal-most position to a proximal-mostposition.

First and second actuation cables 3144 and 3146 may be sheathed in aflexible, non-radially expandable, sleeve 3147 or the like. Sleeve 3147functions to ensure that first and second actuation cables 3144 and 3146solely translate in an axial direction and do not deflect radiallyoutward. Each actuation cable 3146, 3148 may be fabricated from asuitable material, i.e., stainless steel, capable of transmitting axialand torsional forces.

Turning now to FIGS. 111-125, a handle assembly for operating,manipulating and/or controlling an endoscopic device, in accordance withanother embodiment of the present disclosure, is generally designated as3200. Handle assembly 3200 includes a housing 3202 having a right-halfsection 3202 a and a left-half section 3202 b joinable to one another bysuitable fastening elements (not shown), such as screws.

Handle assembly 3200 includes a trigger 3204 operatively supported inhousing 3202 and extending therefrom. As will be described in greaterdetail below, trigger 3204 is movable between a first un-actuatedposition, as seen in FIGS. 111-113 and 120, and at least one secondactuated position, as seen in FIGS. 121-122. In use, movement of trigger3204 between the first and second positions results in actuation and/oroperation of an end effector (not shown).

Trigger 3204 is operatively associated or otherwise connected to anactuation mechanism 3210 (see FIGS. 112-114 and 120-124) of handleassembly 3200. As will be described in greater detail below, in use,movement of trigger 3204 between the first and second positions resultsin two operations of an end effector.

As seen in FIGS. 112-114 and 120-124, actuation mechanism 3210 includesa trigger plate 3212 connected to and extending from trigger 3204.Trigger plate 3212 pivotally connects trigger 3204 to housing 3202.Trigger plate 3212 defines a first gear segment 3214 along a proximal orrear edge 3212 a thereof. Trigger plate 3212 defines an arcuate slot3216 therein having a second gear segment 3216 a formed along an upperedge thereof. Slot 3216 has a radius of curvature having its centerlocated on a pivot axis “Y” (see FIG. 113) of trigger 3204.

A gear set 3220 is operatively associated with slot 3216 of triggerplate. Gear set 3220 includes a first gear 3222 configured to mesh withand/or otherwise operatively engage second gear segment 3216 a of slot3216, and a second gear 3224 supported on a common rotational pin 3226as first gear 3222. In this manner, as first gear 3222 is rotated due toa movement of trigger 3204, second gear 3224 is simultaneously and/orconcomitantly rotated.

Second gear 3224 of gear set 3220 is configured to mesh with and/orotherwise operatively engage teeth 3228 of a rack 3228. Rack 3228defines a lumen 3228 b therethrough. Lumen 3228 b of rack 3228 isoriented in a direction tangential to pivot axis “Y”. In one embodiment,lumen 3228 b of rack 3228 is coaxially disposed on a longitudinal “X”axis of an actuation shaft of handle assembly 3200.

As seen in FIGS. 112-114 and 120-124, actuation mechanism 3210 includesa drive or actuation shaft 3230 extending through and operativelyassociated with rack 3228, and a follower block 3232 rotatably supportedon actuation shaft 3230 at a fixed location distal of rack 3228.Actuation shaft 3230 is axially translatable and rotatable relative torack 3228. Follower block 3232 is axially held in position relative toactuation shaft 3230 by a pair of ring clamps 3232 a, 3232 b secured toactuation shaft 3230 at a location distal and proximal of follower block3232. Rack 3228 and follower block 3232 are connected to one another bya biasing member 3234, i.e., a tension spring, extending therebetween.

Actuation mechanism 3210 includes a slip-clutch 3240 supported on aproximal end of actuation shaft 3230. As seen in FIG. 116, slip clutch3240 includes a distal portion 3242 having a distal bevel gear 3242 aconfigured to mesh with and/or otherwise operatively engage first gearsegment 3214 of trigger plate 3212, and a set of proximally-facing gearteeth 3242 b. Slip clutch 3240 further includes a proximal portion 3244having a set of distally-facing gear teeth 3244 a configured to meshwith and/or otherwise operatively engage the set of proximally-facinggear teeth 3242 b of distal portion 3242, and a toothed wheel 3244 blocated proximal of the set of distally-facing gear teeth 3244 a.Toothed wheel 3244 b defines a pair of diametrically opposed teeth 3244c formed therein or thereon. As seen in FIGS. 119, 122 and 125, toothedwheel 3244 b is keyed to actuation shaft 3230 so as to solely enableaxial displacement of toothed wheel 3244 b relative to actuation shaft3244 b.

In operation, as will be discussed in greater detail below, the set ofdistally-facing gear teeth 3244 a cooperate with the set ofproximally-facing gear teeth 3242 b to impart rotation in a singledirection.

Proximal portion 3244 of slip-clutch 3240 is biased against distalportion 3242 of slip-clutch 3240 by a biasing member 3246, such as, forexample, a compression spring or the like, disposed between housing 3202and proximal portion 3244 of slip-clutch 3240. A pawl 3248 isoperatively associated with toothed wheel 3244 b in such a manner so asto permit rotation of toothed wheel 3244 b in a single direction.

As seen in FIGS. 112-114, at least proximally-facing gear teeth 3242 bof distal portion 3242 of slip-clutch 3240 is retained in a hub 3250formed in housing 3202, and at least a boss 3244 d, extending proximallyfrom toothed wheel 3244 b, is retained in a hub 3252 formed in housing3202.

With continued reference to FIGS. 111-125, a method of using and/oroperating handle assembly 3200 is shown and described. As seen in FIG.120, when trigger 3204 is in a first or un-actuated position, rack 3228is at a distal-most position relative to actuation shaft 3230 such thata proximal-most tooth 3228 a thereof meshes with and/or otherwiseoperatively engages second gear 3224 of gear set 3220. Also, as seen inFIG. 120, when trigger 3204 is in a first or un-actuated position, firstgear segment 3214 of trigger plate 3212 is spaced a distance from bevelgear 3242 a of distal portion 3242 of slip clutch 3240.

As seen in FIGS. 120 and 121, as trigger 3204 is squeezed or moved to asecond or at least partially actuated position, as indicated by arrow“A”, second gear segment 3216 a of slot 3216 causes first gear 3222 aswell as second gear 3224 of gear set 3220 to rotate in the direction ofarrow “B”. As first and second gears 3222, 3224 of gear set 3220 arerotated in the “B” direction, second gear 3224 causes rack 3228 to movein the direction of arrow “C” (i.e., in a proximal direction). As rack3228 is moved proximally, actuation shaft 3230 is also moved proximally,in the direction of arrow “C”, due to the connection of follower block3232 to rack 3230 via biasing member 3234. Proximal movement ofactuation shaft 3230 may result in an operation or movement in an endeffector (not shown) connected to a distal end of actuation shaft 3230via an actuation cable 3231.

As seen in FIG. 121, as trigger 3204 is further squeezed or moved in thedirection of arrow “A”, first gear segment 3214 of trigger plate 3212operatively engages bevel gear 3242 a of distal portion 3242 of slipclutch 3240. As trigger 3204 is moved in the direction of arrow “A”,first gear segment 3214 of trigger plate 3212 imparts rotation to bevelgear 3242 a of distal portion 3242 of slip clutch 3240, in the directionof arrow “D”. Rotation of bevel gear 3242 a of distal portion 3242 ofslip clutch 3240 in turn imparts rotation to proximal portion 3244 ofslip clutch 3240, due to the meshing of respective gear teeth 3242 b,3244 a, which in turn imparts rotation to actuation shaft 3230, due tothe keying of toothed wheel 3244 b of proximal portion 3244 to actuationshaft 3230.

As seen in FIGS. 119 and 122, as toothed wheel 3244 b of proximalportion 3244 of slip clutch 3240 is rotated in the direction of arrow“D”, pawl 3248 rides over and against an outer surface thereof.

As seen in FIG. 123, as trigger 3204 is further squeezed or moved in thedirection of arrow “A”, second gear 3224 of gear set 3220 is furtherrotated in the direction of arrow “B” causing rack 3228 to move furtherin the direction of arrow “C”. However, since actuation shaft 3230 hasbottomed out (i.e., movement in the direction of arrow “C” is stopped),rack 3228 is caused to move in the direction of arrow “C” alongactuation shaft 3230, and since follower block 3232 is axially fixedalong actuation shaft 3230, biasing member 3234 is caused to beelongated. Simultaneously or concomitantly therewith, first gear segment3214 of trigger plate 3212 further rotates bevel gear 3242 a of distalportion 3242 of slip clutch 3240 in the direction of arrow “D” furtherrotating actuation shaft 3230 in the direction of arrow “D”, asdescribed above. Rotation of actuation shaft 3230 in the direction ofarrow “D” may result in another operation or movement in an end effector(not shown) connected to a distal end of actuation shaft 3230 via anactuation cable 3231.

Turning now to FIG. 124, as trigger 3204 is released or moved in thedirection of arrow “A1”, opposite to the direction of arrow “A”, secondgear 3224 of gear set 3220 is rotated in the direction of arrow “B1”,opposite to arrow “B”. Second gear 3224 is moved in the direction ofarrow “B1” either by the movement of trigger 3204 in the direction ofarrow “A1” or by the movement of rack 3228 in the direction of arrow“C1”, opposite to the direction of arrow “C”. Rack 3228 is moved in thedirection of arrow “C1” due to the contraction of biasing member 3234approximating rack 3228 toward follower block 3232. The spring bias ofbiasing member 3234, approximating rack 3228 toward follower block 3232,facilitates or aids in the return or movement of trigger 3204 in thedirection of arrow “A1”. As rack 5228 is moved in the direction of arrow“C1” actuation shaft 3230 is also moved in the direction of arrow “C1”.

Simultaneously or concomitantly with the movement of trigger 3204 in thedirection of arrow “A1”, first gear segment 3214 of trigger plate 3212imparts rotation to bevel gear 3242 a of distal portion 3242 of slipclutch 3240 in the direction of arrow “D1”, opposite to the direction ofarrow “D”. As bevel gear 3242 a of distal portion 3242 of slip clutch3240 is rotated in the direction of arrow “D1” gear teeth 3242 b thereofslips-over and/or against teeth 3244 a of proximal portion 3244 of slipclutch 3240, and since proximal portion 3244 of slip clutch 3240 iscammed in the direction of arrow “D”, against the bias of spring 3246,no rotation is imparted to proximal portion 3244 of slip clutch 3240. Inturn, since proximal portion 3244 of slip clutch 3240 does not rotate,no rotation is imparted to actuation shaft 3230.

As seen in FIG. 125, as toothed wheel 3244 b of proximal portion 3244 ofslip clutch 3240 is rotated in the direction of arrow “D1”, pawl 3248abuts against a tooth 3244 c of toothed wheel 3244 b, preventingrotation of toothed wheel 3244 b in the direction of arrow “D1” and inturn preventing rotation of actuation shaft 3230 in the direction ofarrow “D1”.

Movement of actuation shaft 3230 in the direction of arrow “C1” mayresult in yet another operation or movement in an end effector (notshown) connected to a distal end of actuation shaft 3230 via anactuation cable 3231.

Turning now to FIGS. 111-115 and 117-118, handle assembly 3200 furtherincludes an articulation mechanism 3270 supported on and/or in housing3202. Articulation assembly 3270 may be operatively connected to an endeffect (not shown) in order to impart articulation to the end effectoror any other suitable movement or operation to the end effector.

As seen in FIGS. 111-115 and 117-118, articulation mechanism 3270includes a knob or dial 3272 rotatably supported on or in housing 3202,and a gear set 3274 keyed to and shaving a common rotational axis asdial 3272. Gear set 3274 includes a first gear 3274 a and a second gear3274 b each supported on and keyed to a pin 3276 extending therethroughand through dial 3272.

As seen in FIGS. 114 and 115, first gear 3274 a of gear set 3274operatively engages a locking/feedback member 3278 including a finger3278 a biased against the teeth of first gear 3274 a. In operation, asfirst gear 3274 a of gear set 3274 is rotated, due to a rotation of dial3272, finger 3278 a rides over the teach of first gear 3274 a therebyproviding the user with tactile and/or audible feedback. Additionally,when dial 3272 is not rotated, finger 3278 a inter-engages with theteeth of first gear 3274 a to thereby inhibit automatic rotation of dial272 and thus essentially lock or fix the position of dial 3272.

Articulation mechanism 3270 further includes a pair of opposed racks3280 a, 3280 b operatively engaged with and on opposed sides of secondgear 3274 b of gear set 3274. Each rack 3280 a, 3280 b is slidablysupported within a respective channel 3282 a, 3282 b of a support member3282. Each rack 3280 a, 3280 b includes a respective articulation cable3284 a, 3284 b secured thereto. In this manner, during operation, aseach rack 3280 a, 3280 b is displaced so to is each respectivearticulation cable 3284 a, 3284 b.

In operation, as best seen in FIGS. 117 and 118, as second gear 3274 bis rotated in a direction of arrow “E”, due to the rotation of dial3272, first rack 3280 a is moved in a proximal direction (i.e., in thedirection of arrow “F”), thus displacing first articulation cable 3284 ain the direction of arrow “F”, and second rack 3280 b is moved in adistal direction (i.e., in the direction of arrow “F1”, opposite toarrow “F”), thus displacing second articulation cable 3284 b in thedirection of arrow “F1”. It is understood that rotation of dial 3272 inan opposite direction and thus rotation of second gear 3274 b in adirection opposite to arrow “E” will result in movement and/ordisplacement of racks 3280 a, 3280 b and cables 3284 a, 3284 b inopposite directions. Rotation of dial 3272 thus may impart an operationor movement in an end effector (not shown).

Turning now to FIG. 126, an exemplary suture needle, for use with any ofthe endoscopic devices, instruments and assemblies disclosed herein, isgenerally shown as 3360. Suture needle 3360 includes a needle 3362configured and adapted for the intended purpose of operation with any ofthe endoscopic devices, instruments and assemblies disclosed herein andfor performing a surgical suturing procedure, including penetratingtissue and the like.

Suture needle 3360 includes a suture “S” secured thereto according toknown techniques in the art. Suture “S” of suture needle 3360 maycomprise a one-way or barbed suture “S”. Suture “S” includes anelongated body having a plurality of barbs 3364 extending therefrom.Barbs 3364 are oriented such that barbs 3364 cause suture “S” to resistmovement in an opposite direction relative to the direction in whichbarb 3364 faces.

Suitable sutures “S” for use in surgical needle 3360 include, and arenot limited to, those sutures described and disclosed in U.S. Pat. No.3,123,077; U.S. Pat. No. 5,931,855; and U.S. Patent Publication No.2004/0060409, filed on Sep. 30, 2002, the entire content of each ofwhich being incorporated herein by reference.

Turning now to FIGS. 127-132, a handle assembly according to a furtherembodiment of the present disclosure is generally designated as 4200.Handle assembly 4200 is substantially similar to handle assembly 2200and thus will only be discussed in detail herein to the extent necessaryto identify differences in operation and construction thereof.

As seen in FIGS. 127-129, 131 and 132, handle assembly 4200 includes anarticulation assembly 4270 supported on and/or in housing 4202.Articulation assembly 4270 may be operatively connected to any of theend effectors disclosed hereinabove in order to impart multiplearticulations to the end effector or any other suitable movement oroperation to the end effector.

As seen in FIGS. 127-129, 131 and 132, articulation assembly 4270includes a pair of knobs or dials 4272 a, 4272 b rotatably supported onor in housing 4202, and a set of gears 4274 keyed to and sharing acommon rotational axis as dials 4272 a, 4272 b. The set of gears 4274includes a first gear 4274 a keyed to first dial 4272 a and a secondgear 4274 b keyed to second dial 4272 b.

As seen in FIGS. 128, 129, 131 and 132, a first ratchet mechanism 4273 ais operatively associated with first gear 4274 a and first dial 4272 a,and a second ratchet mechanism 4273 b is operatively associated withsecond gear 4274 b and second dial 4272 b. Each ratchet mechanism 4273a, 4273 b is configured so as to maintain the position of respectivefirst and second dials 4272 a, 4272 b relative to housing 4202.

In operation, as first gear 4274 a is rotated, due to a rotation offirst dial 4272 a, first ratchet mechanism 4273 a is actuated therebyproviding the user with tactile and/or audible feedback as well asfixing the position of first dial 4272 a relative to housing 4202.Additionally, when first dial 4272 a is not rotated, as mentioned above,first ratchet mechanism 4273 a inhibits automatic rotation of first dial4272 and thus essentially locks or fixes the position of first dial 4272a. The operation of second gear 4272 b is substantially similar to theoperation of first gear 4272 a and thus will not be discussed in furtherdetail herein.

Articulation assembly 4270 further includes two pairs of opposed racks4280 a, 4280 b each pair being operatively engaged with and disposed onopposed sides of respective first and second gears 4274 a, 4274 b. Eachpair of racks 4280 a, 4280 b is slidably supported within respectivechannels 4282 a, 4282 b formed in a support member 4282. Each rack ofthe pair of racks 4280 a, 480 b includes an articulation cable 4284 a,4284 b secured thereto. In this manner, during operation, as each rackof the pair of racks 4280 a, 4280 b is displaced so to is eachrespective articulation cable 4284 a, 4284 b.

In operation, as first gear 4274 a is rotated in a first direction, dueto the rotation of first dial 4272 a, the first pair of racks 4280 a aredisplaced in opposite directions to one another, thus displacingrespective articulation cables 4284 a, 4284 b in opposite directions toone another. It is understood that rotation of first dial 4272 a in anopposite direction and thus rotation of first gear 4274 b in an oppositedirection will result in movement and/or displacement of the respectivepair of racks 4280 a and cables 4284 a, 4284 b in opposite directions.Rotation of first dial 4272 b thus may impart an operation, movement orfirst articulation in any of the articulatable end effectors disclosedherein.

Also, in operation, as second gear 4274 b is rotated in a firstdirection, due to the rotation of second dial 4272 b, the second pair ofracks 4280 b are displaced in opposite directions to one another, thusdisplacing respective articulation cables 4284 a, 4284 b in oppositedirections to one another. It is understood that rotation of second dial4272 b in an opposite direction and thus rotation of second gear 4274 bin an opposite direction will result in movement and/or displacement ofthe respective pair of racks 4280 a and cables 4284 a, 4284 b inopposite directions. Rotation of second dial 4272 b thus may impart anoperation, movement or second articulation in any of the articulatableend effectors disclosed herein.

As seen in FIGS. 127, 128 and 130-132, handle assembly 4200 furtherincludes a needle loading assembly 4300 including a knob 4310 supportedon a rear end of housing 4202 and configured to enable loading of asurgical needle (not shown) in the jaws of an end effector disclosedherein. Knob 4310 is coupled to a keyed shaft 4312 via a keyed rotationhub 4314. Keyed rotation hub 4314 has a shaped outer surface for receiptin a complementary shaped recess formed in knob 4310 such that rotationof knob 4310 results in rotation of keyed rotation hub 4314. Keyedrotation hub 4314 defines a shaped lumen 4314 a (FIG. 130) for receiptof a complementary shaped outer surface of keyed shaft 4312 such thatrotation of knob 4310 also results in rotation of keyed shaft 4312.

Keyed rotation hub 4314 includes an annular flange 4314 a defining ashoulder 4314 b. In use, keyed rotation hub 4314 is permitted to rotatein a single direction due to the blocking of rotation in an oppositedirection by the abutment of shoulder 4314 b against a stop 4314 c.

Keyed rotation hub 4314 further includes a distal annular rim 4314 ddefining a flat 4314 e. Flat 4314 e of keyed rotation hub 4314 isconfigured to selectively cooperate and engage with a release switch4315 supported on or pivotally connected to housing 4202. In use, whenswitch 4315 is in registration with flat 4314 e of keyed rotation hub4314, keyed rotation hub 4314 is prevented from rotating and knob 4310is prevented from rotating. When switch 4315 is out of registration withflat 4314 e of keyed rotation hub 4314, keyed rotation hub 4314 is freeto rotate and thus knob 4310 is free to rotate.

As seen in FIGS. 128 and 130-132, a distal end of keyed shaft 4312 isfixedly secured to a proximal end of an actuation shaft 4230 (a distalend of actuation shaft 4230 may be connected to an actuation cableextending in to the end effectors).

In use, in order to load a surgical needle into jaws of an end effector,release switch 4315 is moved in order to free rotation of knob 4310.Knob 4310 is then rotated, thereby rotating keyed shaft 4312, actuationshaft 4230, the actuation cable and the camming hub (as describedabove). As knob 4310 is rotated, the blades of the end effector aremoved axially until the distal ends of the blades are out ofregistration with the needle receiving recesses (as described above).With the distal ends of the blades out of registration with thereceiving recesses of the jaws, a surgical needle is inserted into oneof the receiving recesses. Knob 4310 is then rotated until the distalend of one of the blades engages the surgical needle, as describedabove.

With the surgical needle loaded, release switch 4315 may bere-registered with flat 4314 e of keyed rotation hub 4314, therebypreventing further rotation of knob 4310. It is contemplated thatrelease switch 4315 may be biased to the registration position by asuitable biasing member 4315 a.

Handle assembly 4200 may include a ratchet mechanism 4290 connected totrigger 4204. Ratchet mechanism 4290 include a ratchet rack 4292supported in housing 4202, and a pawl 4294 supported on trigger 4204 andoperatively engaged with ratchet rack 4292. Ratchet mechanism 4290 isconfigured such that trigger 4202 can not be opened without thecompletion of the stroke.

Turning now to FIGS. 133-142, a handle assembly according to a furtherembodiment of the present disclosure is generally designated as 5200.Handle assembly 5200 is substantially similar to handle assembly 2200and thus will only be discussed in detail herein to the extent necessaryto identify differences in operation and construction thereof.

As seen in FIGS. 133-135 and 137-140, handle assembly 5200 includes anarticulation assembly 5270 supported on and/or in housing 5202.Articulation assembly 5270 may be operatively connected to any of theend effectors disclosed hereinabove in order to impart multiplearticulations to the end effector or any other suitable movement oroperation to the end effector.

As seen in FIGS. 133-135 and 137-140, articulation assembly 5270includes a pair of knobs or dials 5272 a, 5272 b rotatably supported onor in housing 5202, and a set of gears 5274 keyed to and sharing acommon rotational axis as dials 5272 a, 5272 b. The set of gears 5274includes a first gear 5274 a keyed to first dial 5272 a and a secondgear 5274 b keyed to second dial 5272 b.

As seen in FIGS. 133-135 and 137-140, a first ratchet mechanism 5273 ais operatively associated with first gear 5274 a and first dial 5272 a,and a second ratchet mechanism 5273 b is operatively associated withsecond gear 5274 b and second dial 5272 b. Each ratchet mechanism 5273a, 5273 b is configured so as to maintain the position of respectivefirst and second dials 5272 a, 5272 b relative to housing 5202.

In operation, as first gear 5274 a is rotated, due to a rotation offirst dial 5272 a, first ratchet mechanism 5273 a is actuated therebyproviding the user with tactile and/or audible feedback as well asfixing the position of first dial 5272 a relative to housing 5202.Additionally, when first dial 5272 a is not rotated, as mentioned above,first ratchet mechanism 5273 a inhibits automatic rotation of first dial5272 and thus essentially locks or fixes the position of first dial 5272a. The operation of second gear 5272 b is substantially similar to theoperation of first gear 5272 a and thus will not be discussed in furtherdetail herein.

Articulation assembly 5270 further includes two pairs of opposed racks5280 a, 5280 b each pair being operatively engaged with and disposed onopposed sides of respective first and second gears 5274 a, 5274 b. Eachpair of racks 5280 a, 5280 b is slidably supported within respectivechannels 5282 a, 5282 b formed in a support member 5282. Each rack ofthe pair of racks 5280 a, 580 b includes an articulation cable 5284 a,5284 b secured thereto. In this manner, during operation, as each rackof the pair of racks 5280 a, 5280 b is displaced so to is eachrespective articulation cable 5284 a, 5284 b.

In operation, as first gear 5274 a is rotated in a first direction, dueto the rotation of first dial 5272 a, the first pair of racks 5280 a aredisplaced in opposite directions to one another, thus displacingrespective articulation cables 5284 a, 5284 b in opposite directions toone another. It is understood that rotation of first dial 5272 a in anopposite direction and thus rotation of first gear 5274 b in an oppositedirection will result in movement and/or displacement of the respectivepair of racks 5280 a and cables 5284 a, 5284 b in opposite directions.Rotation of first dial 5272 b thus may impart an operation, movement orfirst articulation in/of end effector 5100. For example, end effector5100 may be articulated in the direction of arrows “A” (see FIG. 133).

Also, in operation, as second gear 5274 b is rotated in a firstdirection, due to the rotation of second dial 5272 b, the second pair ofracks 5280 b are displaced in opposite directions to one another, thusdisplacing respective articulation cables 5284 a, 5284 b in oppositedirections to one another. It is understood that rotation of second dial5272 b in an opposite direction and thus rotation of second gear 5274 bin an opposite direction will result in movement and/or displacement ofthe respective pair of racks 5280 a and cables 5284 a, 5284 b inopposite directions. Rotation of second dial 5272 b thus may impart anoperation, movement or second articulation in/of end effector 5100. Forexample, end effector 5100 may be articulated in the direction of arrows“B” (see FIG. 133).

Handle assembly 5200 further includes a needle loading assembly 5300including a knob 5310 supported on a rear end of housing 5202 andconfigured to enable loading of a surgical needle in jaws. Needleloading assembly 5300 is substantially similar to needle loadingassembly 2300, shown and described above, and thus reference may be madeto needle loading assembly 2300 for a detailed discussion of theconstruction and operation of needle loading assembly 5300.

In general, needle loading assembly 5330 includes a knob 5310 keyed to aspline shaft 5312 via a nut 5314. Nut 5314 has a shaped outer surfacefor receipt in a complementary shaped recess formed in knob 5310 suchthat rotation of knob 5310 results in rotation of nut 5314. Spline shaft5312 is axially slidably disposed within lumen 5314 a of nut 5314. Adistal end of spline shaft 5312 extends through slip-clutch 5240 and isfixedly secured to a proximal end of actuation shaft 5230 (a distal endof actuation shaft 5230 being connected to actuation cable 5142).

In use, in order to load a surgical needle 104 into the jaws of endeffector 5100, knob 5310 is rotated, thereby rotating spline shaft 5312,actuation shaft 5230, actuation cable 5142 and camming hub 2144 (asdescribed above). As knob 5310 is rotated blades 2150, 2152 are movedaxially until the distal ends of blades 2150, 2152 are out ofregistration with needle receiving recesses 2130 a, 2132 a. With thedistal ends of blades 2150, 2152 out of registration with receivingrecesses 2130 a, 2132 a of jaws 2130, 2132, a surgical needle 104 isinserted into one of the receiving recesses 2130 a, 2132 a. Knob 5310 isthen rotated until the distal end of one of blades 2150, 2152 engagessurgical needle 104, as described above.

With continued reference to FIGS. 133, 134 and 137-142, housing 5202 ofhandle assembly 5200 may define a passage 5203 extending therethroughwhich has an open distal end and an open proximal end. Passage 5203 isconfigured and dimensioned to selectively receive and guide a surgicalinstrument therethrough. Suitable surgical instruments which may beintroduced into and through passage 5203 include and are not limited toendoscopic graspers and/or forceps.

As seen in FIG. 137, a channel 5103 may be connected to or otherwisesecured to end effector 5100. Channel 5103 may extend from passage 5203thereby defining a continuous passage from handle assembly 5200, alongthe neck portion and through to or proximate the tool assembly. In thismanner, in use, the surgical instrument may be advanced through passage5203 of handle assembly 5200 and through channel 5103 such that a distalend portion of the surgical instrument is in close proximity to the toolassembly in order to help or assist with the surgical procedure.

In this manner, end effector 5100 and the surgical instrument may beintroduced into the target surgical site through the same or a commoncorporal opening.

Channel 5103 may be secured to an outer surface of the neck portion insuch a manner so as to not interfere with the articulation of the neckportion and to not occlude the passage extending therethrough. Channel5103 may be secured to the neck portion using adhesives, straps,shrink-wrapping or the like.

While the disclosure has been particularly shown and described withreference to particular embodiments, it will be understood by thoseskilled in the art that various modifications in form and detail may bemade therein without departing from the scope and spirit of theinvention. Accordingly, modifications such as those suggested above, butnot limited thereto, are to be considered within the scope of theinvention.

1. An endoscopic stitching device, comprising: an articulatable neckassembly configured and adapted for articulation in at least onedirection transverse to a longitudinal axis thereof; a tool assemblyoperatively supported on a distal end of the neck assembly, the toolassembly including: a pair of juxtaposed jaws pivotally associated withone another, each jaw defining a needle receiving recess formed in atissue contacting surface thereof; a rotatably supported camming hub,the camming hub defining a central lumen therethrough and a grooveformed in an inner surface thereof; and a center rod slidably androtatably disposed within the lumen of the camming hub, the center rodbeing operatively engaged with the groove formed in the inner surface ofthe camming hub and being operatively engaged with the pair of jaws; anda suture needle operatively associated with the tool assembly; whereinthe inner groove of the camming hub is configured such that, in at leastone position, axial translation of the center rod relative to thecamming hub results in rotation of the camming hub and at least one ofopening and closing of the pair of jaws; and wherein the inner groove ofthe camming hub is configured such that, in at least one other position,rotation of the center rod results in rotation of the tool assembly. 2.The endoscopic stitching device according to claim 1, wherein the grooveformed in the inner surface of the camming hub includes a pair ofdiametrically opposed axially oriented grooves, and a pair of helicalgrooves interconnecting the axially oriented grooves.
 3. The endoscopicstitching device according to claim 2, wherein the tool assembly furtherincludes a pair of axially translatable needle engaging blades slidablysupported, one each, in a respective jaw, each blade having an advancedposition wherein a distal end of the blade engages a suture needle whenthe suture needle is in the respective jaw to thereby secure the sutureneedle to the jaw, and a retracted position wherein the distal end ofthe blade is out of engagement with the suture needle to thereby permitthe suture needle to be removed from the jaw.
 4. The endoscopicstitching device according to claim 3, wherein the camming hub defines ahelical groove formed in an outer surface thereof, and wherein aproximal end of each blade is configured for slidable engagement in thehelical groove of the camming hub.
 5. The endoscopic stitching deviceaccording to claim 4, wherein rotation of the camming hub results inreciprocal axial translation of the pair of blades in oppositedirections to one another.
 6. The endoscopic stitching device accordingto claim 5, wherein the tool assembly includes a support member defininga lumen therein, wherein the camming hub is rotatably supported in thelumen of the support member, and wherein the camming hub is fixedagainst axial movement within the lumen of the support member.
 7. Theendoscopic stitching device according to claim 6, wherein the camminghub defines an annular groove formed in the outer surface thereof,wherein the outer annular groove of the camming hub slidably receives aprojection of the support member therein.
 8. The endoscopic stitchingdevice according to claim 7, further comprising an actuation cabletranslatably and rotatably extending through the neck assembly, whereina distal end of the actuation cable is operatively connected to thecenter rod.
 9. The endoscopic stitching device according to claim 8,wherein the actuation cable is translatable to axially translate thecenter rod between a first position wherein the jaws are spaced apartfrom one another and a second position wherein the pair of jaws are in aclose spaced relation to one another.
 10. The endoscopic stitchingdevice according to claim 1, further comprising a pair of articulationcables slidably extending through the neck assembly and having a distalend fixedly connected to the tool assembly.
 11. The endoscopic stitchingdevice according to claim 1, wherein the suture needle includes a barbedsuture.
 12. The endoscopic stitching device according to claim 3,wherein the tool assembly further includes a keyed block disposeddistally of the camming hub, wherein the keyed block defines a lumentherethrough and a pair of diametrically opposed, axially extendinggrooved formed in an inner surface of the lumen, wherein the axialgrooves are configured to slidably receive a respective blade therein.13. An endoscopic stitching device, comprising: a tool assemblyincluding: a pair of juxtaposed jaws pivotally associated with oneanother; a rotatably supported camming hub, the camming hub defining acentral lumen therethrough and a groove formed in an inner surfacethereof; and a center rod slidably and rotatably disposed within thelumen of the camming hub, the center rod being operatively engaged withthe groove formed in the inner surface of the camming hub and beingoperatively engaged with the pair of jaws; wherein the inner groove ofthe camming hub is configured such that, in at least one position, axialtranslation of the center rod relative to the camming hub results inrotation of the camming hub and at least one of opening and closing ofthe pair of jaws; and wherein the inner groove of the camming hub isconfigured such that, in at least one other position, rotation of thecenter rod results in rotation of the tool assembly.
 14. The endoscopicstitching device according to claim 13, further comprising anarticulatable neck assembly configured and adapted for articulation inat least one direction transverse to a longitudinal axis thereof,wherein the tool assembly is supported on a distal end of the neckassembly.
 15. The endoscopic stitching device according to claim 13,wherein each jaw defines a needle receiving recess formed in a tissuecontacting surface thereof.
 16. The endoscopic stitching deviceaccording to claim 13, wherein the groove formed in the inner surface ofthe camming hub includes a pair of diametrically opposed axiallyoriented grooves, and a pair of helical grooves interconnecting theaxially oriented grooves.
 17. The endoscopic stitching device accordingto claim 16, wherein the tool assembly further includes a pair ofaxially translatable needle engaging blades slidably supported, oneeach, in a respective jaw, each blade having an advanced positionwherein a distal end of the blade engages a suture needle when thesuture needle is in the respective jaw to thereby secure the sutureneedle to the jaw, and a retracted position wherein the distal end ofthe blade is out of engagement with the suture needle to thereby permitthe suture needle to be removed from the jaw.
 18. The endoscopicstitching device according to claim 17, wherein the camming hub definesa helical groove formed in an outer surface thereof, and wherein aproximal end of each blade is configured for slidable engagement in thehelical groove of the camming hub.
 19. The endoscopic stitching deviceaccording to claim 18, wherein rotation of the camming hub results inreciprocal axial translation of the pair of blades in oppositedirections to one another.
 20. The endoscopic stitching device accordingto claim 13, wherein the tool assembly includes a support memberdefining a lumen therein, wherein the camming hub is rotatably supportedin the lumen of the support member, and wherein the camming hub is fixedagainst axial movement within the lumen of the support member.
 21. Theendoscopic stitching device according to claim 20, wherein the camminghub defines an annular groove formed in the outer surface thereof,wherein the outer annular groove of the camming hub slidably receives aprojection of the support member therein.
 22. The endoscopic stitchingdevice according to claim 14, further comprising an actuation cabletranslatably and rotatably extending through the neck assembly, whereina distal end of the actuation cable is operatively connected to thecenter rod.
 23. The endoscopic stitching device according to claim 22,wherein the actuation cable is translatable to axially translate thecenter rod between a first position wherein the jaws are spaced apartfrom one another and a second position wherein the pair of jaws are in aclose spaced relation to one another.
 24. The endoscopic stitchingdevice according to claim 14, further comprising a pair of articulationcables slidably extending through the neck assembly and having a distalend fixedly connected to the tool assembly.
 25. The endoscopic stitchingdevice according to claim 17, wherein the tool assembly further includesa keyed block disposed distally of the camming hub, wherein the keyedblock defines a lumen therethrough and a pair of diametrically opposed,axially extending grooved formed in an inner surface of the lumen,wherein the axial grooves are configured to slidably receive arespective blade therein.
 26. The endoscopic stitching device accordingto claim 13, further comprising a suture needle operatively associatedwith the tool assembly.
 27. The endoscopic stitching device according toclaim 26, wherein the suture needle includes a barbed suture.